S-1-based therapy versus S-1 monotherapy in advanced gastric cancer: a meta-analysis

Abstract

This study aimed to derive a more precise estimate of the prognostic significance of S-1-based therapy over S-1 monotherapy in patients with advanced gastric cancer (AGC), including overall survival (OS) time, progression-free survival (PFS) time, objective response rate (ORR), and adverse events (AEs). Studies stratifying OS, PFS, ORR, and AEs in AGC patients in an S-1-based therapy versus an S-1 monotherapy setting were eligible for analysis by systematic computerized PubMed, Embase and Cochrane Library searches. Data from these studies were pooled using STATA package version 11.0. Six studies that investigated outcomes in a total of 913 AGC cases, of which 443 (48.5%) received S-1-based therapy and 470 (51.5%) received S-1 monotherapy, were included in the meta-analysis. Median OS and median PFS were significantly prolonged in AGC patients receiving S-1-based therapy compared with those receiving S-1 monotherapy (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.71-0.96, P = 0.015, and HR 0.69, 95% CI 0.60-0.80, P = 0.000, respectively). The ORR favored patients with S-1-based therapy (OR 1.65, 95% CI 1.34-2.06, P = 0.000). Higher incidence of grade 3/4 neutropenia was found in patients with S-1-based therapy (P = 0.000). For the Asian population, S-1-based therapy significantly improved OS and PFS and enhanced ORR in comparison to S-1 monotherapy. The safety profile was poorer in patients with S-1-based therapy, but could be considerable between the S-1-based therapy and S-1 monotherapy group. Our conclusion needs to be confirmed via high-quality trials and the results need to be reproduced in other regions and populations.

Management of advanced gastric cancer: An overview of major findings from meta-analysis

“…All the included meta-analyses indicated that S-1 combination therapy was superior to monotherapy in terms of OS and PFS [7, 20, 23]. As for RR, two of them favored S-1 combination therapy in objective RR [7, 23] while another one meta-analysis indicated that S-1 was favorable regarding overall RR [20].…”

“…All the included meta-analyses indicated that S-1 combination therapy was superior to monotherapy in terms of OS and PFS [7, 20, 23]. As for RR, two of them favored S-1 combination therapy in objective RR [7, 23] while another one meta-analysis indicated that S-1 was favorable regarding overall RR [20]. All the meta-analyses demonstrated that S-1 combination therapy was associated with higher incidence of AEs or grade 3-4 toxicity event [7, 20, 23].…”

A Retrospective Comparison of Trastuzumab Plus Cisplatin and Trastuzumab Plus Capecitabine in Elderly HER2-Positive Advanced Gastric Cancer Patients

“…Results from a meta-analysis indicated that S-1-based therapy showed significant ORR, longer PFS, and longer OS than S-1 monotherapy, although with higher incidence of grade 3 to 4 neutropenia. 5 In a retrospective trail that compared S-1 plus cisplatin (SP) to capecitabine plus cisplatin (XP), SP and XP were associated with similar efficacy and safety in AGC patients. 16 However, for elderly HER2-positive ACG patients, trastuzumab might be a better treatment option than S-1.…”

“… 3 S-1, as a new novel oral fluoropyrimidine agent, has already been confirmed to show promising anticancer efficacy for AGC. 4 , 5 Because the S-1 plus cisplatin (SP) chemotherapy regimen is accepted as the standard therapy for AGC in Japan, 6 this combination has been studied in several completed clinical trials. 7 , 8 However, this regimen consistently produces high incidences of grade 3 to 4 hematological toxicities.…”

Letter regarding Wu JR et al.: S-1-based therapy versus S-1 monotherapy in advanced gastric cancer: a meta-analysis

“…To the Editor, Wu JR et al [1] conducted a meta-analysis to derive a precise estimation of the prognostic significance of S-1-based therapy over S-1 monotherapy in patients with advanced gastric cancer (AGC) including overall survival (OS) time, progression-free survival (PFS) time, objective response rate (ORR), and adverse events (AEs). Before their results can be accepted, we have several worthwhile queries that we would like to communicate with the investigators.…”