Comparative effectiveness of adjuvant treatments for resected gastric cancer: a network meta-analysis

Cai, Zhaolun; Yin, Yu; Yin, Yuan; Shen, Chaoyong; Wang, Jian; Yin, Xiaonan; Chen, Zhuo; Zhou, Ye; Zhang, Bo

doi:10.1007/s10120-018-0831-0

Cited by 27 publications

(21 citation statements)

References 45 publications

(67 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 5-Fu based doublet treatment, eg, with a oxaliplatin cisplatin or paclitaxel analog, has demonstrated some survival benefit for patients with resectable GC or GEJ, and is widely adopted across China. [23][24][25] Although 5-Fu has been the backbone of treatment for LAGC for decades, the toxicity, tolerance, completion rate, and prognosis differ among mono, dual, and triplet therapies. 26,27 Currently, 5-Fu based combinations are widely adopted for advanced gastric cancer in Asia and recently in European countries.…”

Section: Discussionmentioning

confidence: 99%

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

Liu¹,

Wang²,

Shan³

et al. 2021

CMAR

View full text Add to dashboard Cite

Background: The duration and the optimal time to adjuvant chemotherapy (TAC) in locally advanced gastric cancer (LAGC) have net not been sufficiently demonstrated. Sequential adjuvant chemotherapy (AC) after neoadjuvant chemotherapy plus gastrectomy is increasingly utilized, making the question more complicated. Patients and Methods: Data were collected from patients with LAGC who underwent 5-Fu-based doublet regimens as adjuvant treatment after gastrectomy in a single-center database. TAC and duration (cycles) were used to evaluate survival outcomes. Results: A total of 816 patients were included. Patients received over six cycles and TAC less than 42 days significantly correlated with better survival (log-rank P trend <0.001). The analysis of TAC and number cycles were separately applied in perioperative chemotherapy (PEC) and postoperative chemotherapy (POC) group using Cox regression. The number of cycles revealed a statistical significance improving OS rate both in POC (HR=0.904, 95% CI=0.836-0.977, P=0.011) and PEC (HR=0.887, 95% CI=0.798-0.986, P=0.026), while only in POC did the TAC show an increasing trend of risk with borderline significance (OS: HR=1.008, 95% CI=0.999-1.018, P=0.094; PFS: HR=1.009, 95% CI=1.000-1.018, P=0.055). A spline model demonstrates the less improvement in survival after cycles of chemotherapy reaching six. Conclusion: Our findings suggest that TAC is more likely to downregulate the survival benefit in POC rather than PEC, while overall survival is susceptible to cumulative cycles of chemotherapy in both groups. Furthermore, six cycles of chemotherapy tended to reach the maximum survival benefits. Prospective confirmation is required.

show abstract

Section: Discussionmentioning

confidence: 99%

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

Liu¹,

Wang²,

Shan³

et al. 2021

CMAR

View full text Add to dashboard Cite

show abstract

“…On the basis of evidence for improved overall survival (OS) and/or disease-free survival (DFS) from randomized phase III clinical trials (2-7), fluoropyrimidine (FU)-based adjuvant chemotherapy or chemoradiotherapy is recommended for patients with resected stage II-III GC and select patients with stage Ib GC who exhibit positive nodes or risk factors for relapse. Several meta-analyses have further confirmed the efficacy of adjuvant chemotherapy or chemoradiotherapy for these patients (8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 93%

Association Between the Microsatellite Instability Status and the Efficacy of Postoperative Adjuvant Chemoradiotherapy in Patients With Gastric Cancer

Dai

Zhao

et al. 2020

Front. Oncol.

View full text Add to dashboard Cite

The effect of microsatellite instability (MSI) on the response to radiotherapy remains unknown. The aim of this study was to investigate the association between the MSI status and the outcomes of gastric cancer (GC) treated by surgical resection with or without postoperative adjuvant chemoradiotherapy. Methods: The records of patients who underwent surgical resection of stage IB-III GC with or without postoperative adjuvant chemoradiotherapy were retrospectively retrieved from the Affiliated Hospital of Jiangsu University (n = 89), The Cancer Genome Atlas (n = 202), and the Asian Cancer Research Group (n = 138). The primary endpoint was overall survival (OS). Results: The MSI status had no significant influence on OS in all cohorts. Compared with surgery alone, adjuvant chemoradiotherapy improved or tended to improve OS of patients with stage III disease, irrespective of the MSI status, in all cohorts. Among patients with stage Ib/II disease, only those with microsatellite stability (MSS) benefited from chemoradiotherapy in terms of OS, whereas those with MSI showed no improvement in OS. A comparison of gene expression profiles between MSI stage Ib/II GC and MSS stage Ib/II GC revealed that MSI correlated with the overexpression of thymidylate synthetase, a marker of fluoropyrimidine resistance. Furthermore, tumor hypoxia scoring for stage Ib/II lesions showed significantly greater hypoxia in MSI tumors than in MSS tumors. Conclusions: The findings of this study suggest that postoperative adjuvant chemoradiotherapy is effective for stage III GC, regardless of the MSI status. However, MSI may predict a poor response to postoperative adjuvant chemoradiotherapy in patients with stage Ib/II GC.

show abstract

“…However, all PARP inhibitors have never been compared with each other because of the lack of head-to-head trials. Although recent traditional meta-analyses have been published on PARP inhibitors as maintenance treatment in platinum sensitive ROC ( 3 – 6 ), comparisons among the three drugs were little explored because of the limitation of traditional meta-analysis methods which is based on direct evidence ( 9 ). Thus, the comparative efficacy and safety of FDA-approved PARP inhibitors as maintenance treatment in platinum sensitive ROC is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy and Safety of PARP Inhibitors as Maintenance Therapy in Platinum Sensitive Recurrent Ovarian Cancer: A Network Meta-Analysis

Ding

Tian

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

This meta-analysis investigated the comparative efficacy and safety of PARP inhibitor monotherapy as maintenance treatment in platinum sensitive recurrent ovarian cancer (ROC). Electronic databases were systematically searched for relevant RCTs. The primary endpoint was PFS. The results were stratified based on three categories: BRCA mutated patients, HRD patients, and overall population. The secondary outcome were discontinuations due to adverse events and grade 3 or 4 adverse events in maintenance phase. Five eligible RCTs were included in the network meta-analysis. For patients with BRCA mutated ovarian cancer, olaparib-throughout (HR = 0.21 with 95% CrI: 0.081–0.55), rucaparib (HR = 0.23 with 95% CrI: 0.16–0.34), olaparib (HR = 0.27 with 95% CrI: 0.20–0.35), and niraparib (HR = 0.26 with 95% CrI: 0.17–0.41) were all highly effective in comparison with placebo at improving PFS. For HRD patients, both rucaparib (HR = 0.32 with 95% CrI: 0.24–0.42) and niraparib (HR = 0.38 with 95% CrI: 0.24–0.60) were all highly effective in comparison with placebo at improving PFS. For the overall population, olaparib-throughout (HR = 0.51 with 95% CrI: 0.34–0.76), rucaparib (HR = 0.37 with 95% CrI: 0.30–0.45), olaparib (HR = 0.35 with 95% CrI: 0.25–0.49), and niraparib (HR = 0.38 with 95% CrI: 0.30–0.48) were all highly effective in comparison with placebo at improving PFS. Regarding grade 3 or 4 adverse events, the incidence of grade 3 or 4 toxicity reactions to rucaparib and niraparib were significantly higher than in the olaparib group. In terms of discontinuations due to adverse events, the treatment discontinuations were not significantly different between the three drugs. In summary, all the included maintenance treatment regimens are effective regardless of BRCA mutational status, and no statistically significant differences between rucaparib, niraparib and Olaparib in terms of PFS. In terms of safety profile, the three drugs present manageable adverse events. Clinicians should consider potential adverse events related to each of these interventions in clinical practice, and the adverse events are generally manageable.

show abstract

Comparative effectiveness of adjuvant treatments for resected gastric cancer: a network meta-analysis

Cited by 27 publications

References 45 publications

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

Association Between the Microsatellite Instability Status and the Efficacy of Postoperative Adjuvant Chemoradiotherapy in Patients With Gastric Cancer

Comparative Efficacy and Safety of PARP Inhibitors as Maintenance Therapy in Platinum Sensitive Recurrent Ovarian Cancer: A Network Meta-Analysis

Contact Info

Product

Resources

About