Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: A meta-analysis and meta-regression
Journal
Gastric Cancer
Journal Volume
15
Journal Issue
3
Pages
265-280
Date Issued
2012
Author(s)
Abstract
Background The standard of chemotherapy regimens for advanced or metastatic gastric cancer and the clinical outcome were heterogeneous in Asian versus non-Asian countries. This study aimed to explore predictors of safety and efficacy of chemotherapy for patients with advanced or metastatic gastric cancer. Methods Treatment group-based meta-analysis and metaregression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines. Results Twenty-five trials (8 Asian, 17 Western or international) with 56 treatment groups were analyzed. Asian trials reported a lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffusetype histology, and more frequent use of second-line chemotherapy. Meta-analysis revealed significant heterogeneity both in treatment safety (grade 3-4 neutropenia and diarrhea) and efficacy [6-month progression-free survival (PFS) and 1-year overall survival (OS)]. Meta-regression analyses indicate that Asian trials are associated with an 8.2% lower incidence of grade 3-4 neutropenia and 2.1% lower incidence of grade 3-4 diarrhea. A lower percentage of patients with gastroesophageal junction carcinoma and the use of combination regimens predicted better PFS. The use of second-line chemotherapy predicts better 1-year OS, which will increase by 10% for every 10% increase in patients who received second-line chemotherapy. Conclusion Geographic region (Asian vs. non-Asian) is an independent predictor of safety in systemic therapy for gastric cancer. ? 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.
SDGs
Other Subjects
capecitabine; cisplatin; docetaxel; doxorubicin; epirubicin; etoposide; fluorouracil; folinic acid; gimeracil plus oteracil potassium plus tegafur; irinotecan; oxaliplatin; paclitaxel; adult; aged; article; Asia; cancer chemotherapy; cancer prognosis; continuous infusion; diarrhea; drug efficacy; drug megadose; drug safety; esophagus carcinoma; female; gastroesophageal carcinoma; geographic distribution; human; incidence; major clinical study; male; meta analysis; neutropenia; overall survival; priority journal; progression free survival; randomized controlled trial (topic); regression analysis; stomach carcinoma; systematic review; Antineoplastic Agents; Asia; Carcinoma; Diarrhea; Disease-Free Survival; Esophageal Neoplasms; Europe; Humans; Neutropenia; Randomized Controlled Trials as Topic; Stomach Neoplasms; Treatment Outcome; United States
Type
journal article