Meta-Analysis
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World J Gastroenterol. Jan 7, 2014; 20(1): 310-318
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.310
S-1-based combination therapy vs S-1 monotherapy in advanced gastric cancer: A meta-analysis
Guo-Fang Liu, Dong Tang, Ping Li, Su Wang, Ya-Xiang Xu, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Jie Chen, Xiao-Xing Xiang
Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People’s Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China
Dong Tang, Ping Li, Ya-Xiang Xu, Jie Chen, Department of Gastrointestinal Surgery, Subei People’s Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China
Author contributions: Liu GF and Xiang XX conceived the study; Liu GF and Tang D collected data and performed data analysis; all authors designed the study, wrote the paper, read and approved the final manuscript for submission.
Correspondence to: Xiao-Xing Xiang, Adjunct Professor, Chief Physician, Department of Gastroenterology and Hepatology, Subei People’s Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Nantong West Road No.98, Yangzhou 225000, Jiangsu Province, China. yzxiangxx@sina.com
Telephone: +86-131-96492771 Fax: +86-514-87373375
Received: September 4, 2013
Revised: October 11, 2013
Accepted: October 17, 2013
Published online: January 7, 2014
Processing time: 138 Days and 6 Hours
Abstract

AIM: To assess the efficacy and safety of combination therapy based on S-1, a novel oral fluoropyrimidine, vs S-1 monotherapy in advanced gastric cancer (AGC).

METHODS: We searched PubMed, EMBASE and the Cochrane Library for eligible studies published before March 2013. Our analysis identified four randomized controlled trials involving 790 participants with AGC. The outcome measures were overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and grade 3-4 adverse events.

RESULTS: Meta-analysis showed that S-1-based combination therapy significantly improved OS (HR = 0.77, 95%CI: 0.66-0.91, P = 0.002), PFS (HR = 0.58, 95%CI: 0.46-0.72, P = 0.000) and ORR (OR = 2.23, 95%CI: 1.54-3.21, P = 0.000). Sensitivity analysis further confirmed this association. Lower incidence of grade 3-4 leucopenia (OR = 4.06, 95%CI: 2.11-7.81), neutropenia (OR = 3.94, 95%CI: 2.1-7.81) and diarrhea (OR = 2.41, 95%CI: 1.31-4.44) was observed in patients with S-1 monotherapy.

CONCLUSION: S-1-based combination therapy is superior to S-1 monotherapy in terms of OS, PFS and ORR. S-1 monotherapy is associated with less toxicity.

Keywords: S-1; Advanced gastric cancer; Meta-analysis; Overall survival; Chemotherapy

Core tip: This is the first meta-analysis aimed to detect whether S-1-based combination therapy would be more effective and safer than S-1 monotherapy in patients with advanced gastric cancer (AGC). In the meta-analysis, the S-1-based combination therapy group shows great advantages of achieving better overall survival, progression-free survival and overall response rate for AGC compared with the S-1 monotherapy group. The grade 3-4 adverse events in the combination therapy group might be overcome with medical therapy. S-1-based combination therapy should be used as a standard chemotherapeutic regimen for AGC, at least in Asia.