Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.600
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
Gastric cancer has always been a disease with high morbidity and mortality in the world. Because of the lack of obvious symptoms and signs in the early stage, many patients are found to have been diagnosed in the advanced stage. At the same time, none of the first-line treatments for advanced gastric cancer is standard. At present, docetaxel, cisplatin, and 5-fluorouracil (DCF) and epirubicin, cisplatin, and 5-fluorouracil (ECF) are both effective first-line regimens for clinical use, but in many countries, different researchers have different opinions. There are still many disputes about the advantages and disadvantages of these two regimens. The results in some studies showed that the DCF group was better than the ECF group. However, in other studies, opposite results were obtained. To solve the controversy, we conducted this meta-analysis.
In many studies, both DCF and ECF regimens have shown good outcomes, but on the other hand, they also show many disadvantages, especially in the adverse effects (AEs). Since there is still much controversy in this field, and there is lack of evidence of evidence-based medicine in relevant fields to prove that which regimen is more suitable for clinical use, it is necessary to conduct relevant meta-analysis. This study therefore aimed to provide a more focused analysis through the evaluation of the survival outcomes and AEs between DCF and ECF regimens.
Our primary objective was to analyze the efficacy of the two first-line regimens in the treatment of advanced gastric cancer by obtaining the best and latest data from clinical trials. In the discussion section, we cited many frontier studies in related fields, and focused on the analysis of the reasons for the difference in therapeutic effect between DCF and ECF regimens. At the same time, we also hope that our research can play a guiding and helpful role in clinical medication.
We conducted this meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven main databases were searched up to August 31, 2018. Search results were limited to original human studies, and search criteria were restricted to randomized controlled trials or cohort studies without language restriction. We selected studies according to the PICOS principle. The Jadad scale and the Newcastle-Ottawa Scale were used to assess quality of the studies, and RevMan and STATA were used to analyze the data. Progression-free survival (PFS) and overall survival (OS) were analyzed by the pooled hazard ratio. Objective response rate (ORR), disease control rate (DCR), and AEs were analyzed by the pooled risk ratio. The heterogeneity test was evaluated by using the Q test and I2 statistic. If P > 0.1 and I2 < 50%, the fixed effects model was used. Otherwise, the random effects model was used.
Our meta-analysis included seven high quality articles and 598 patients with advanced gastric cancer for the final analysis to compare the efficacy and safety of the DCF regimen and ECF regimen. The results showed that DCF and ECF were both effective with comparable PFS (95%CI: 0.58-1.46, P = 0.73) and OS (95%CI: 0.65-1.10, P = 0.21). The DCF group showed significantly better ORR (95%CI: 1.13-1.75, P = 0.002) and DCR (95%CI: 1.03-1.41, P = 0.02) than the ECF group. We evaluated toxicities between the DCF and ECF groups based on total (all-grade/grade 3-4) AEs. The AEs between the two groups were only significantly different in the aspects of neutropenia (95%CI: 1.25-2.16, P = 0.0003) and febrile neutropenia (95%CI: 1.17-4.12, P = 0.01), while other toxicities showed no statistically significant differences between the two groups.
This study is the latest meta-analysis to compare DCF and ECF regimens for advanced gastric cancer. From this result, we conclude that DCF regimen seems to be more suitable for advanced gastric cancer than the ECF regimen. This finding is extremely important for the research and guidance of clinical medication in related fields. DCF regimen, like most drugs, is not perfect and in some respects shows some unsatisfactory aspects. We cannot deny the effectiveness of DCF in the treatment of advanced gastric cancer, but we cannot ignore its side effects.
Our evidence of evidence-based medicine is mainly based on the original clinical research, but at present it seems that the research in related fields is still very deficient, which directly leads to the great limitation of our access to clinical evidence. Although there is still much controversy about the first-line drug use in the treatment of advanced gastric cancer, because gastric cancer cells are relatively sensitive to chemotherapeutic drugs, it is expected that larger clinical trials in the future can be conducted for related research.