Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2014; 20(33): 11886-11893
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11886
S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer: A meta-analysis
Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu
Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People’s Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China
Author contributions: Yang J, Zhou Y and Xu CN collected and analyzed the data, wrote and revised the manuscript; Min K and Yao Q provided analytic tools and checked the accuracy of the data; Xu CN conceived, designed and supervised the study.
Correspondence to: Chun-Ni Xu, Professor, Department of Oncology, Affiliated Yixing People’s Hospital, Jiangsu University, Tongzhenguan Road No.75, Wuxi 214200, Jiangsu Province, China. staff911@yxph.com
Telephone: +86-510-87330792 Fax: +86-510-87330792
Received: February 26, 2014
Revised: April 24, 2014
Accepted: May 25, 2014
Published online: September 7, 2014
Abstract

AIM: To assess the efficacy and tolerability of S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer (AGC).

METHODS: We extracted reported endpoints, including overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), objective response rate (ORR) and adverse effects, from randomized controlled trials identified in PubMed, the Cochrane library, Science Direct, EMBASE and American Society of Clinical Oncology meetings. Stata software was used to calculate the pooled values.

RESULTS: Seven randomized controlled trials involving 2176 patients were included in this meta-analysis. Compared to non-S-1-based regimens, the use of S-1-based regimens were associated with an increase in ORR (RR = 1.300; 95%CI: 1.028-1.645); OS (HR = 0.89; 95%CI: 0.81-0.99; P = 0.025), TTF (HR = 0.83; 95%CI: 0.75-0.92; P = 0.000), and a lower risk of febrile neutropenia (RR = 0.225; P = 0.000) and stomatitis (RR = 0.230; P = 0.032). OS, PFS and TTF were prolonged, especially in the Asian population. In subgroup analysis, statistically significant increases in ORR (RR = 1.454; P = 0.029), OS (HR = 0.895; P = 0.041) and TTF (HR = 0.832; P = 0.000) were found when S-1-based chemotherapy was compared to 5-fluorouracil (5-FU)-based chemotherapy. The incidence of leukopenia (RR = 0.584; P = 0.002) and stomatitis (RR = 0.230; P = 0.032) was higher in the 5-FU-based arm. S-1-based regimens had no advantage in ORR, OS, PFS, TTF and grade 3 or 4 adverse events over capecitabine-based regimens.

CONCLUSION: S-1-based chemotherapy may be a good choice for AGC because of longer survival times, better tolerance and more convenient use.

Keywords: S-1, Advanced gastric cancer, Chemotherapy, First line treatment, Meta-analysis

Core tip: This meta-analysis aimed to assess the efficacy and tolerability of S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer (AGC). Compared to non-S-1-based regimens, the use of S-1-based regimens were associated with an increase in the objective response rate, overall survival, time-to-treatment failure, and a lower risk of grade 3 or 4 adverse events. S-1-based chemotherapy may be a good choice for AGC, at least in Asia because of longer survival times, better tolerance and more convenient use.