Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2019; 7(5): 600-615
Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.600
Docetaxel, cisplatin, and 5-fluorouracil compared with epirubicin, cisplatin, and 5-fluorouracil regimen for advanced gastric cancer: A systematic review and meta-analysis
Bo Li, Lian Chen, Hong-Liang Luo, Feng-Ming Yi, Yi-Ping Wei, Wen-Xiong Zhang
Bo Li, Yi-Ping Wei, Wen-Xiong Zhang, Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Bo Li, Lian Chen, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
Hong-Liang Luo, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Feng-Ming Yi, Department of Digestive Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Li B conceptualized and designed the study, acquired, analyzed, and interpreted the data, and drafted the article; Chen L and Luo HL acquired, analyzed, and interpreted the data; Yi FM conceptualized and designed the study and analyzed and interpreted the data; Wei YP revised the article; Zhang WX conceptualized and designed the study, critically revised the manuscript, and approved the final version.
Supported by National Natural Science Foundation of China, No. 81560345.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read and revised according to the PRISMA 2009 Checklist.
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/
Corresponding author: Wen-Xiong Zhang, MD, Attending Doctor, Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang 330006, Jiangxi Province, China. zwx123dr@126.com
Telephone: +86-18720909414 Fax: +86-791-86311248
Received: October 31, 2018
Peer-review started: October 31, 2018
First decision: December 12, 2018
Revised: December 20, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: March 6, 2019
Abstract
BACKGROUND

As the first-line regimens for the treatment of advanced gastric cancer, both docetaxel, cisplatin, and 5-fluorouracil (DCF) and epirubicin, cisplatin, and 5-fluorouracil (ECF) regimens are commonly used in clinical practice, but there is still controversy about which is better.

AIM

To compare the efficacy and safety of DCF and ECF regimens by conducting this meta-analysis.

METHODS

Computer searches in PubMed, EMBASE, Ovid MEDLINE, Science Direct, Web of Science, The Cochrane Library and Scopus were performed to find the clinical studies of all comparisons between DCF and ECF regimens. We used progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse effects (AEs) as endpoints for analysis.

RESULTS

Our meta-analysis included seven qualified studies involving a total of 598 patients. The pooled hazard ratios between the DCF and ECF groups were comparable in PFS (95%CI: 0.58-1.46, P = 0.73), OS (95%CI: 0.65-1.10, P = 0.21), and total AEs (95%CI: 0.93-1.29, P = 0.30). The DCF group was significantly better than the ECF group in terms of ORR (95%CI: 1.13-1.75, P = 0.002) and DCR (95%CI: 1.03-1.41, P = 0.02). However, the incidence rate of grade 3-4 AEs was also greater in the DCF group than in the ECF group (95%CI: 1.16-1.88, P = 0.002), especially for neutropenia and febrile neutropenia.

CONCLUSION

With better ORR and DCR values, the DCF regimen seems to be more suitable for advanced gastric cancer than the ECF regimen. However, the higher rate of AEs in the DCF group still needs to be noticed.

Keywords: Gastric cancer, Chemotherapy, Docetaxel, Epirubicin, Cisplatin, 5-fluorouracil

Core tip: This study is the first meta-analysis to compare docetaxel, cisplatin, and 5-fluorouracil (DCF) and epirubicin, cisplatin, and 5-fluorouracil (ECF) regimens for advanced gastric cancer. The results showed that progression-free survival (PFS), overall survival (OS), and total adverse effects (AEs) between the DCF and ECF groups were comparable. The DCF group was significantly better in terms of ORR and DCR than the ECF group. However, the incidence rate of grade 3-4 AEs was also greater in the DCF group than in the ECF group, especially for neutropenia and febrile neutropenia. Therefore, DCF regimen seems to be more suitable for advanced gastric cancer than the ECF regimen.