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Overall survival benefits for irinotecan-containing regimens as first-line treatment for advanced gastric cancer: an updated meta-analysis of ten randomized controlled trials.

Abstract
The standard treatment for patients with advanced gastric cancer (AGC) is still debated, and the available data on the benefit of irinotecan-containing regimen as first-line treatment for those patients are controversial. We performed a systematic review and meta-analysis of randomized controlled trials to determine the survival benefits of irinotecan-containing regimens in this setting. A total of 1,837 patients from ten trials were included in the analysis. Our results showed that irinotecan-containing regimens significantly improved overall survival [OS: hazard ratio (HR) 0.86, 95% CI = 0.78-0.94, p = 0.002] and progression-free survival [HR = 0.82, 95% CI = 0.69-0.97, p = 0.026); however, the improvement of time to failure (HR = 0.90; 95% CI = 0.77-1.04, p = 0.15), 1-year survival rate [1-year SR: relative risk (RR) 1.10, 95% CI = 0.97-1.24, p = 0.13] and overall response rate (RR = 1.16, 95% CI = 0.91-1.49, p = 0.24] were nonsignificant. Equivalent frequencies of toxicities were found between the two groups excluding more Grade 3 or 4 fatigue (p = 0.001) in irinotecan-containing regimens. This updated meta-analysis provided strong evidence for a survival benefit of irinotecan-containing regimen as first-line treatment for AGC. A clear advantage of irinotecan-containing over nonirinotecan-containing regimen had not been established. These results should help to inform decisions about patient management and design of future trials.
AuthorsWei-Xiang Qi, Zan Shen, Feng Lin, Yuan-Jue Sun, Da-Liu Min, Li-Na Tang, Ai-Na He, Yang Yao
JournalInternational journal of cancer (Int J Cancer) Vol. 132 Issue 2 Pg. E66-73 (Jan 15 2013) ISSN: 1097-0215 [Electronic] United States
PMID22890856 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
CopyrightCopyright © 2012 UICC.
Chemical References
  • Irinotecan
  • Camptothecin
Topics
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Camptothecin (administration & dosage, analogs & derivatives)
  • Disease-Free Survival
  • Humans
  • Induction Chemotherapy
  • Irinotecan
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Stomach Neoplasms (drug therapy, mortality, pathology)
  • Treatment Outcome

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