Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis
Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis
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DOI：
10.1093/annonc/mdt351
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发表时间：
2013-11-01
影响因子：
50.5
通讯作者：
Zang, D. Y.
中科院分区：
文献类型：
--
作者：
Kim, H. S.;Kim, H. J.;Zang, D. Y.
一线化疗后的难治性或复发性胃癌患者在常规临床实践中接受了挽救性化疗。然而，没有证据支持这种治疗，直到最近的III期临床试验显示总体生存期显著延长。因此，我们对这些试验进行了荟萃分析，并调查二线化疗是否比最佳支持治疗更有效。我们检索了科克伦对照试验中心注册中心（CENTRAL，2013年第1期）、MEDLINE（1950年至2013年3月第4周）和EMBASE（1980年至2013年，第13周）。此外，我们检索了2004年至2013年美国临床肿瘤学会（ASCO）会议的所有摘要和虚拟会议报告。检索过程中获得了578项研究，其中2项是比较化疗与支持治疗的随机III期试验。从2004年至2013年ASCO的摘要和虚拟会议报告中，识别出127篇评价二线化疗的摘要;仅1篇相关摘要纳入荟萃分析。共有410例患者符合分析条件，其中150例接受多西他赛化疗，81例接受伊立替康化疗。挽救化疗组死亡风险显著降低[HR = 0.64，95%可信区间（CI）0.52-0.79，P < 0.0001]，当分析仅限于伊立替康或多西他赛时，每种化疗药物的死亡风险仍显著降低。伊立替康和多西他赛的HR分别为0.55（95%CI 0.40-0.77，P = 0.0004）和0.71（95%CI 0.56-0.90，P = 0.004），该荟萃分析显示了支持进展期胃癌二线化疗的证据。
Many patients with refractory or relapsed gastric cancer after first-line chemotherapy have received salvage chemotherapy in routine clinical practice. However, there was no evidence to support this treatment until recent phase III trials demonstrated substantial prolongation of overall survival. Therefore, we conducted a meta-analysis of these trials and investigated whether second-line chemotherapy was more effective than best supportive care.We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2013), MEDLINE (1950 to March week 4, 2013) and EMBASE (1980-2013, week 13). In addition, we searched all abstracts and virtual meeting presentations from the American Society of Clinical Oncology (ASCO) conferences held between 2004 and 2013.The search process yielded 578 studies, two of which were randomized phase III trials that compared chemotherapy with supportive care. From the abstracts and virtual meeting presentations of ASCO held between 2004 and 2013, 127 abstracts were identified that evaluated second-line chemotherapy; only one relevant abstract was included in the meta-analysis.A total of 410 patients were eligible for analysis, of whom 150 received docetaxel chemotherapy, and 81 received irinotecan chemotherapy. A significant reduction in the risk of death [HR = 0.64, 95% confidence interval (CI) 0.52-0.79, P < 0.0001] was observed with salvage chemotherapy.When the analysis was restricted to irinotecan or docetaxel, there was still significant reduction in the risk of death with each chemotherapeutic agent. The HR was 0.55 (95% CI 0.40-0.77, P = 0.0004) for irinotecan and 0.71 (95% CI 0.56-0.90, P = 0.004) for docetaxel.This meta-analysis demonstrated evidence to support second-line chemotherapy in advanced gastric cancer.