Chemotherapy for advanced gastric cancer

Area of Science:

• Oncology
• Gastroenterology
• Clinical Trials

Background:

• Gastric cancer is a leading cause of cancer mortality globally.
• Advanced stages and post-surgical relapse are common in Western countries.
• Limited targeted therapies exist, primarily for HER2-positive disease.

Purpose of the Study:

• To evaluate the efficacy of various chemotherapy regimens for advanced gastric cancer.
• To compare chemotherapy against best supportive care (BSC).
• To assess combination versus single-agent chemotherapy and different drug combinations.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched major databases (Cochrane, MEDLINE, Embase) up to June 2016.
• Included 64 RCTs with 11,698 participants for overall survival analysis.

Main Results:

• Chemotherapy extends overall survival (OS) by approximately 6.7 months versus BSC (moderate-quality evidence).
• Combination chemotherapy offers a slight OS benefit over single-agent chemotherapy, with increased toxicity (moderate-quality evidence).
• Irinotecan and docetaxel-containing regimens show modest OS benefits; oxaliplatin may offer a slight advantage over cisplatin (high to low-quality evidence).

Conclusions:

• Systemic chemotherapy is the mainstay for advanced gastric cancer, improving survival.
• Combination regimens provide marginal benefits, necessitating careful consideration of toxicity.
• Specific agents like irinotecan and docetaxel show survival advantages, while HER2 status guides targeted therapy selection.