Cancer Res Treat.  2017 Jan;49(1):255-262. 10.4143/crt.2015.452.

Irinotecan Monotherapy Versus Irinotecan-Based Combination as Second-Line Chemotherapy in Advanced Gastric Cancer: A Meta-Analysis

• Cho YH
• Yoon SY
• Kim SN

• KMID: 2367523
• DOI: http://doi.org/10.4143/crt.2015.452

Abstract

PURPOSE
A meta-analysis was conducted to examine the question of whether combination regimens are more effective than monotherapy as a second-line chemotherapy in advanced gastric cancer.
MATERIALS AND METHODS
The MEDLINE and the EMBASE databases and the Cochrane Central Register for Controlled Trials were searched using appropriate keywords. Only randomized controlled trials were eligible.
RESULTS
Taxane-based study is rare; thus, four irinotecan-based studies were finally included in the meta-analysis. Out of 661 patients, 331 patients were assigned to combination therapy and 330 to monotherapy. Cisplatin or fluoropyrimidine (S-1 or 5-fluorouracil) was used as a combination partner to irinotecan. The pooled hazard ratio (HR) for overall survival (OS) and for progression-free survival (PFS) was 0.938 (95% confidence interval [CI], 0.796 to 1.104; p=0.442) and 0.815 (95% CI, 0.693 to 0.958; p=0.013). In subgroup analysis according to previous exposure to a partner agent, the PFS benefit of combination was observed only in the partially exposed group (HR, 0.784; 95% CI, 0.628 to 0.980; p=0.032).
CONCLUSION
Second-line irinotecan-based combination was not associated with increased OS, but with PFS benefit, which seemed particularly significant for patients receiving combination with a new agent.

Keyword

Stomach neoplasms; Chemotherapy; Second-line; Irinotecan; Monotherapy; Combination drug therapy; Meta-analysis; Survival

MeSH Terms

Cisplatin
Disease-Free Survival
Drug Therapy*
Drug Therapy, Combination
Humans
Stomach Neoplasms*
Cisplatin

Figure

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  Fig. 1. Flow chart of the literature search.

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  Fig. 2. Potential bias of the trials by the Cochrane Risk of Bias assessment [16-19].

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  Fig. 3. Standard forest plot of the hazard ratio (HR) for death for combination regimen versus monotherapy [16-19]. CI, confidence interval.

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  Fig. 4. Standard forest plot of the hazard ratio (HR) for progression for combination regimen versus monotherapy [16-19]. CI, confidence interval.

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  Fig. 5. Subgroup analysis based on the degree of previous exposure to chemo-drugs: forest plot of the hazard ratio (HR) for death [16-19]. CI, confidence interval.

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  Fig. 6. Subgroup analysis based on the degree of previous exposure to chemo-drugs: forest plot of the hazard ratio (HR) for progression [16-19]. CI, confidence interval.

Reference

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