Cited by 1,171Gastric Cancer Management and OutcomesColorectal Cancer Treatments and StudiesIntraperitoneal and Appendiceal Malignancies

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Chemotherapy in Advanced Gastric Cancer: A Systematic Review and Meta-Analysis Based on Aggregate Data

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Wagner, Anna D., Grothe, Wilfried, Haerting, Johannes, Kleber, Gerhard, Grothey, Axel, Fleig, Wolfgang E.·2006·Journal of Clinical Oncology

DOI 10.1200/jco.2005.05.0245

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Abstract

Purpose: This systematic review and meta-analysis were performed to assess the efficacy and tolerability of chemotherapy in patients with advanced gastric cancer. Methods: Randomized phase II and III clinical trials on first-line chemotherapy in advanced gastric cancer were identified by electronic searches of Medline, Embase, the Cochrane Controlled Trials Register, and Cancerlit; hand searches of relevant abstract books and reference lists; and contact to experts. Meta-analysis was performed using the fixed-effect model. Overall survival, reported as hazard ratio (HR) with 95% CI, was the primary outcome measure. Results: Analysis of chemotherapy versus best supportive care (HR = 0.39; 95% CI, 0.28 to 0.52) and combination versus single agent, mainly fluorouracil (FU) -based chemotherapy (HR = 0.83; 95% CI = 0.74 to 0.93) showed significant overall survival benefits in favor of chemotherapy and combination chemotherapy, respectively. In addition, comparisons of FU/cisplatin-containing regimens with versus without anthracyclines (HR = 0.77; 95% CI, 0.62 to 0.95) and FU/anthracycline-containing combinations with versus without cisplatin (HR = 0.83; 95% CI, 0.76 to 0.91) both demonstrated a significant survival benefit for the three-drug combination. Comparing irinotecan-containing versus nonirinotecan-containing combinations (mainly FU/cisplatin) resulted in a nonsignificant survival benefit in favor of the irinotecan-containing regimens (HR = 0.88; 95% CI, 0.73 to 1.06), but they have never been compared against a three-drug combination. Conclusion: Best survival results are achieved with three-drug regimens containing FU, an anthracycline, and cisplatin. Among these, regimens including FU as bolus exhibit a higher rate of toxic deaths than regimens using a continuous infusion of FU, such as epirubicin, cisplatin, and continuous-infusion FU.

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Chemotherapy for advanced gastric cancer
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“3,4 However, there are a series of obvious defects in chemotherapy.”
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Background
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“For patients with recurrent or metastatic diseases, systemic chemotherapy with best supportive care can prolong median overall survival (OS) from 3-4 months to approximately 10-13 months [5,6].”
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Background
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Background
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Influential
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Background
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Background
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Rhee, J., Han, S., Oh, D., Im, S., Kim, T., & Bang, Y. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2010.06289.x · Cited by 34
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“in patients with advanced gastric cancer suggest that the combination chemotherapy response rates prevail over monotherapy alone (11).”
Background
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“단독항암화학요법 혹은 보존적 치료만 받은 경우에 비하여 통 계적으로 유의하게 생존기간을 증가시킨다.(115) 진행성 위암의”
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“Although a large number of chemotherapy agents have been tested in studies, there is no internationally accepted standard of treatment (Wagner et al., 2006).”
Background
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Seo, M.-D., Lee, K.-W., Lim, J., Yi, H. G., Kim, D.-Y., Oh, D., Kim, J. H., Im, S., Kim, T.-Y., Lee, J. S., et al. (2008) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyn078 · Cited by 33
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“[111]”
A three-gene signature as potential predictive biomarker for irinotecan sensitivity in gastric cancer
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“However, the median survival remained below one year [2], and the response rate was only approximately 30%-50% [4].”
Background
Comparison of efficacy and safety of first-line palliative chemotherapy with EOX and mDCF regimens in patients with locally advanced inoperable or metastatic HER2-negative gastric or gastroesophageal junction adenocarcinoma: a randomized phase 3 trial
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Background
Postoperative chemoradiotherapy versus chemotherapy for R0 resected gastric cancer with D2 lymph node dissection: an up-to-date meta-analysis
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“the principal active ingredients of saffron, have potential antiproliferative effects (5,21,22) and have been revealed to suppress the growth of a variety of cancer cells via arresting the cell cycle and inducing cell apoptosis.”
Background
Gene expression of 5-fluorouracil metabolic enzymes in primary gastric cancer: Correlation with drug sensitivity against 5-fluorouracil
Kodera, Y., Ito, S., Fujiwara, M., Mochizuki, Y., Nakayama, G., Ohashi, N., Koike, M., Yamamura, Y., & Nakao, A. (2007) · Cancer Letters · doi:10.1016/j.canlet.2007.01.006 · Cited by 32
A phase II study of modified FOLFOX as first-line chemotherapy in elderly patients with advanced gastric cancer
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Jeong, S. H., Han, J. H., Kim, J., Ahn, M. S., Hwang, Y. H., Lee, H. W., Kang, S. Y., Park, J. S., Choi, J., Lee, K. J., et al. (2010) · Digestive Diseases and Sciences · doi:10.1007/s10620-010-1280-8 · Cited by 31
“The median survival of 12 months in the present patient cohort is comparable to the outcomes in large phase III clinical trials for palliative chemotherapy of advanced gastric cancer [2–6, 8].”
BackgroundResultInfluential
CCL2 expression correlates with Snail expression and affects the prognosis of patients with gastric cancer
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Indian Council of Medical Research consensus document for the management of gastric cancer
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“A metaanalysis of first-line chemotherapy studies in metastatic gastric cancer has shown that the best survival results are achieved with three-drug regimens containing anthracycline, 5-FU, and cisplatin.[24] The REAL-2 Study showed that capecitabine and oxaliplatin are as effective as 5-FU and cisplatin, respectively.”
Background
Prognostic factor analysis of third-line chemotherapy in patients with advanced gastric cancer
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Authors: Wagner, A. D., Grothe, W., Haerting, J., Kleber, G., Grothey, A., & Fleig, W. E.
Affiliations: From the First Department of Medicine, Coordinating Centre for Clinical Trials, Department of Medicine IV, and Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany; and Mayo Clinic College of Medicine, Rochester, MN
Mayo Clinic (US)
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2006-06-20
Volume: 24
Issue: 18
Pages: 2903-2909
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.2005.05.0245
OpenAlex: W2145390243
Cited by: 1,171
References: 51
Citations by year: 2026: 7 · 2025: 15 · 2024: 26 · 2023: 28 · 2022: 34 · 2021: 64 · 2020: 55 · 2019: 54 · 2018: 69 · 2017: 89 · 2016: 72 · 2015: 84 · 2014: 105 · 2013: 92 · 2012: 77
FWCI: 9.54
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed (publishedVersion)
Funders: American Society of Clinical Oncology
Bundesministerium für Bildung und Forschung (01GH0105)
Topics: Health Sciences › Medicine › Oncology › Gastric Cancer Management and Outcomes
Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
Keywords: advanced gastric cancer, first-line chemotherapy, 5-fluorouracil, cisplatin, anthracyclines, irinotecan, combination chemotherapy, overall survival, best supportive care, epirubicin, chemotherapy toxicity
MeSH terms: Antineoplastic Combined Chemotherapy Protocols, Humans, Stomach Neoplasms

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Chemotherapy in Advanced Gastric Cancer: A Systematic Review and Meta-Analysis Based on Aggregate Data

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