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Comparative efficacy and tolerability of third-line treatments for advanced gastric cancer: A systematic review with

Sejung Park1, Chung Mo Nam2, Seul-Gi Kim3

  • 1Department of Biostatistics and Computing, Yonsei University College of Medicine, Seoul, South Korea; Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.

European Journal of Cancer (Oxford, England : 1990)
|December 18, 2020
PubMed
Abstract

Insights

Immunotherapy (nivolumab) and antiangiogenic agents (regorafenib, apatinib) show promise as third-line treatments for advanced gastric cancer. These agents offer a favorable benefit-risk ratio compared to chemotherapy for improving patient outcomes.

Area of Science:

  • Oncology
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • The optimal third-line treatment for advanced/metastatic gastric cancer (AGC) remains undefined.
  • Identifying effective and tolerable therapeutic options is crucial for improving patient survival and quality of life.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the efficacy and tolerability of various third-line treatments for AGC.
  • To provide evidence-based guidance for selecting the most appropriate treatment strategies.

Main Methods:

  • A comprehensive literature review of randomized clinical trials (RCTs) across four electronic databases.
  • Bayesian network meta-analysis using a random-effects model to assess overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).

Main Results:

  • Nine treatments from seven RCTs involving 2601 patients were analyzed.
  • Nivolumab plus ipilimumab demonstrated the greatest OS benefit, while regorafenib and apatinib showed superior PFS.
  • Nivolumab and combination nivolumab/ipilimumab improved ORR, but the combination had higher toxicity; nivolumab, apatinib, and regorafenib offered the best benefit-risk ratio.

Conclusions:

  • Third-line immunotherapy (nivolumab) or antiangiogenic agents (regorafenib, apatinib) as monotherapy provide significant benefit-risk advantages.
  • These findings can guide clinical decision-making for third-line treatment selection in advanced gastric cancer.
Keywords:
Advanced gastric cancerAntiangiogenic agentsBayesian analysisImmunotherapyNetwork meta-analysisSystematic reviewThird-line treatments

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