S-1-Based Chemotherapy versus Capecitabine-Based Chemotherapy as First-Line Treatment for Advanced Gastric Carcinoma: A Meta-AnalysisReport as inadecuate




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Background

Although both oral fluoropyrimidines were reported effective and safe, doubts exist about whether S-1 or capecitabine is more advantageous in advanced gastric carcinoma AGC. Herein, we performed a meta-analysis to comprehensively compare the efficacy and safety of S-1-based chemotherapy versus capecitabine-based chemotherapy as first-line treatment for AGC.

Methods

PubMed-Medline, EmBase, Cochrane library, and China National Knowledge Infrastructure databases were searched for articles comparing S-1-based chemotherapy to capecitabine-based chemotherapy for AGC. Primary outcomes were overall response rate ORR, time to progression TTP, overall survival OS, progression-free probability, and survival probability. Secondary outcomes were toxicities. Fixed-effects model were used and all the results were confirmed by random-effects model.

Results

Five randomized controlled trials and five cohort studies with 821 patients were included. We found equivalent ORR 38.3% vs. 39.1%, odds ratio OR 0.92, 95% confidence interval CI 0.69-1.24, P = 0.59, TTP harzad ratio HR 0.98, 95% CI 0.82-1.16, P = 0.79, OS HR 0.99, 95% CI 0.87-1.13, P = 0.91, progression-free probability 3-month OR 1.02, 95% CI 0.62-1.68, P = 0.94; 6-month OR 1.34, 95% CI 0.88-2.04, P = 0.18 and survival probability 0.5-year OR 0.90, 95% CI 0.61-1.31, P =0.57; 1-year OR 0.97, 95% CI 0.70- 1.33, P = 0.84; 2-year OR 1.15, 95% CI 0.61-2.17, P = 0.66. Equivalent grade 3 to 4 hematological and non-hematological toxicities were found except hand-foot syndrome was less prominent in S-1-based chemotherapy 0.3% vs. 5.9%, OR 0.19, 95% CI 0.06-0.56, P = 0.003. There’re no significant heterogeneity and publication bias. Cumulative analysis found stable time-dependent trend. Consistent results stratified by study design, age, regimen, cycle, country were observed.

Conclusion

S-1-based chemotherapy was associated with non-inferior antitumor efficacy and better safety profile, compared with capecitabine-based therapy. We recommended S-1 and capecitabine can be used interchangeably for AGC, at least in Asia.



Author: Ming-ming He , Wen-jing Wu , Feng Wang , Zhi-qiang Wang, Dong-sheng Zhang, Hui-yan Luo, Miao-zhen Qiu, Feng-hua Wang, Chao Ren, Z

Source: http://plos.srce.hr/



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