Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4358-4364
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4358
Efficacy of S-1 vs capecitabine for the treatment of gastric cancer: A meta-analysis
An-Bing He, Xiu-Lan Peng, Jia Song, Ji-Xing Zhang, Wei-Guo Dong, Ren-Feng Luo, Yan Tang
An-Bing He, Xiu-Lan Peng, Yan Tang, Department of Oncology, the Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
Jia Song, Ji-Xing Zhang, Wei-Guo Dong, Department of Medical College, Jiang Han University, Wuhan 430056, Hubei Province, China
Wei-Guo Dong, Ren-Feng Luo, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Author contributions: Peng XL and He AB contributed equally to this work; Peng XL, He AB and Dong WG conceived and designed the paper; Song J, Zhang JX and Peng XL searched the data; Zhang JX, Song J, Peng XL and Tang Y analyzed the data; Peng XL, Zhang JX, He AB and Dong WG wrote the manuscript; all authors contributed to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Guo Dong, MD, Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan 430060, Hubei Province, China. dongwg66@163.com
Telephone: +86-27-88041911 Fax: +86-27-88041911
Received: July 15, 2014
Peer-review started: July 16, 2014
First decision: August 15, 2014
Revised: September 12, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: April 14, 2015
Processing time: 273 Days and 11.4 Hours
Abstract

AIM: To rationally evaluate the effect of S-1 vs capecitabine for the treatment of gastric cancer.

METHODS: MEDLINE, EMBASE, Cochrane Controlled Trials Register, Google Scholar, and China Journal Full Text Database were accessed to collect clinical randomized controlled trials regarding the effect of S-1 vs capecitabine for the treatment of gastric cancer patients. Statistical analysis was performed by meta-analysis. Four randomized controlled trials met the inclusion criteria.

RESULTS: Compared with capecitabine regimens, the 1-year survival rate in gastric cancer patients was 0.80 (95%CI: 0.52-1.21, P = 0.29). The overall response rate of S-1 vs capecitabine was 0.94 (95%CI: 0.59-1.51, P = 0.93). Compared with capecitabine regimens, the most frequent hematologic toxicities were neutropenia (OR = 0.99, 95%CI: 0.65-1.49, P = 0.94) and thrombocytopenia (OR = 0.72, 95%CI: 0.31-1.67, P = 0.44). The most frequent non-hematologic toxicities included nausea (OR = 0.85, 95%CI: 0.56-1.28, P = 0.43) and hand-foot syndrome (OR = 0.16, 95%CI: 0.10-0.27, P < 0.00001).

CONCLUSION: The existing studies suggest that S-1 is not more effective than capecitabine in the treatment of gastric cancer patients, but does exhibit less toxicity with regard to hand-foot syndrome.

Keywords: Gastric cancer; S-1; Capecitabine; Randomized controlled trials; Meta-analysis

Core tip: Systemic chemotherapy has proven to be an important treatment for advanced gastric cancer patients. A combination regimen containing 5-fluorouracil is most commonly used worldwide. S-1 and capecitabine are both oral fluoropyrimidine carbamates, and have proven to be effective for the treatment of gastric cancer patients. This is the first meta-analysis to systematically compare the effects between S-1 and capecitabine against gastric cancer in order to better understand the efficacy, safety, and feasibility of these anticancer drugs. The results may contribute to better treatment and quality of life for patients with advanced gastric cancer.