Chemotherapy for advanced gastric cancer

Abstract

Background Gastric cancer is the fifth most common cancer worldwide. In "Western" countries, most people are either diagnosed at an advanced stage, or develop a relapse after surgery with curative intent. In people with advanced disease, significant benefits from targeted therapies are currently limited to HER-2 positive disease treated with trastuzumab, in combination with chemotherapy, in first-line. In secondline, ramucirumab, alone or in combination with paclitaxel, demonstrated significant survival benefits. Thus, systemic chemotherapy remains the mainstay of treatment for advanced gastric cancer. Uncertainty remains regarding the choice of the regimen. Objectives To assess the efficacy of chemotherapy versus best supportive care (BSC), combination versus single-agent chemotherapy and different chemotherapy combinations in advanced gastric cancer. Search methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE and Embase up to June 2016, reference lists of studies, and contacted pharmaceutical companies and experts to identify randomised controlled trials (RCTs). Selection criteria We considered only RCTs on systemic, intravenous or oral chemotherapy versus BSC, combination versus single-agent chemotherapy and different chemotherapy regimens in advanced gastric cancer. Data collection and analysis Two review authors independently identified studies and extracted data. A third investigator was consulted in case of disagreements. We contacted study authors to obtain missing information.

Combination versus single-agent as palliative chemotherapy for gastric cancer

“…For patients with recurrent or primary metastatic GC (RPMGC), palliative chemotherapy is the standard of care. In terms of chemotherapy regimen, combination chemotherapy (CC) is generally recommended in clinical practice [3][4][5][6][7]. Two meta-analyses demonstrated a small but statistically significant survival benefit of CC compared to single-agent chemotherapy (SC) [6,7].…”

“…In terms of chemotherapy regimen, combination chemotherapy (CC) is generally recommended in clinical practice [3][4][5][6][7]. Two meta-analyses demonstrated a small but statistically significant survival benefit of CC compared to single-agent chemotherapy (SC) [6,7]. However, individual randomized trials comparing CC and SC gave conflicting results [4,[6][7][8][9][10].…”

“…Two meta-analyses demonstrated a small but statistically significant survival benefit of CC compared to single-agent chemotherapy (SC) [6,7]. However, individual randomized trials comparing CC and SC gave conflicting results [4,[6][7][8][9][10]. Moreover, most randomized trials excluded patients who were elderly or who had poor performance status (PS) [3][4][5][8][9][10][11].…”

Antineoplastic Effect of WIN 55,212-2, a Cannabinoid Agonist, in a Murine Xenograft Model of Gastric Cancer

“…Most patients are either diagnosed at an advanced stage or frequently develop a relapse, in spite of surgery with curative intent. These patients have a median survival time of 3-5 months without chemotherapy even after a curative resection [2]. These data indicate the importance of effective chemotherapy in gastric cancer [3].…”

Pharmacogenetics and Stomach Cancer: An Update

“…Nonetheless, the potential of chemoradiotherapy association to surgery should still be verified in additional controlled clinical trials. Recent reports indicate that, in metastatic disease, chemotherapy significantly improves survival in comparison with the best supportive care, with a benefit in mean average survival of approximately 6 months [6]. However, at present, appropriate chemotherapy treatment for metastatic GC should primarily be guided by the principles of palliative care [7].…”