Dr Anna Wagner and colleagues from Germany assessed the efficacy and tolerability of chemotherapy in patients with advanced gastric cancer.
The research team performed a meta-analysis of randomized phase II and III clinical trials on first-line chemotherapy in advanced gastric cancer.
The team conducted electronic searches of Medline, Embase, the Cochrane Controlled Trials Register, and Cancerlit.
The researchers also conducted hand searches of relevant abstract books and reference lists, and contacted experts.
Meta-analysis was performed using the fixed-effect model.
Overall survival, reported as hazard ratio with 95% confidence intervals, was the primary outcome measure.
|Fluorouracil as bolus vs continuous infusion exhibits a higher rate of toxic deaths|
|Journal of Clinical Oncology|
Chemotherapy vs best supportive care showed significant overall survival benefits in favor of chemotherapy.
The researchers found that overall survival benefits favored combination therapy, when compared with single agent, mainly fluorouracil-based chemotherapy.
In addition, comparisons of fluorouracil/cisplatin-containing regimens with vs without anthracyclines showed a survival benefit for the 3-drug combination.
The team noted that fluorouracil/anthracycline-containing combinations with vs without cisplatin also indicated a survival benefit for the 3-drug combination.
Comparing irinotecan-containing vs nonirinotecan-containing combinations showed a nonsignificant survival benefit in favor of irinotecan-containing regimens.
The researchers point out that these have, however, never been compared against a 3-drug combination.
Dr Wagner's team commented, “Best survival results are achieved with 3-drug regimens containing fluorouracil, an anthracycline, and cisplatin.”
“Among these, regimens including fluorouracil as bolus exhibit a higher rate of toxic deaths than regimens using a continuous infusion of fluorouracil, such as epirubicin, cisplatin, and continuous-infusion fluorouracil.”