Irinotecan-involved regimens for advanced gastric cancer: A pooled-analysis of clinical trials

Wang, Danling; Gu, Dongying; Huang, Huaying; Xu, Zhi; Chen, Jinfei

doi:10.3748/wjg.v16.i46.5889

Cited by 10 publications

(11 citation statements)

References 23 publications

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“…Compared to the studies of Wagner et al 6 and Wang et al, 21 the number of eligible trials in this study was the most. However, this meta-analysis was still far from perfect.…”

Section: Discussionmentioning

confidence: 85%

“…Moreover, the rates of treatment-related deaths in the irinotecancontaining arm were lower than that in the nonirinotecan-containing arm (0.7% vs. 2.6%, respectively). After that the second study reported by Wang et al 21 in 2010 also favored irinotecan-containing regimens without significantly improving OS rate; however, a significant benefit of TTF was observed in irinotecan-containing group. However, several limitations of these two meta-analyses needed to be considered.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Qi¹,

Shen²,

Lin³

et al. 2012

Intl Journal of Cancer

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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 ( Gastric cancer is the fourth most frequent malignant disease and the second most common cause of cancer-related deaths worldwide. A total of 989,600 new gastric cancer cases and 738,000 deaths are estimated to have occurred in 2008, accounting for 8% of the total cases and 10% of total cancerrelated deaths, respectively.1-3 Although the overall incidence of gastric cancer in the Western countries, Japan, Korea and China has decreased, the incidence of proximal gastric cancer has increased. 4 Moreover, the decline in gastric cancer incidence in China has been slower than in the Western countries, Japan and Korea and will be offset by population growth and aging.5 As a result, gastric cancer remains an important public health burden in the world.As for early and locally advanced gastric cancer (AGC), surgery remains the mainstay of curative treatment; however, relapse is common, and the majority of patients present with advanced disease. Although systemic chemotherapy has a proven palliative role in patients with AGC, significantly improving quality of life and prolonging survival compared to best supportive care alone 6 ; the prognosis of patients in this setting remains dismal with overall 5-year survival rate ranging from 10 to 15% in the Western countries, Japan and Korea.7 During the past decades, a large number of chemotherapy regimens including 5-fluorouracil (5-FU) and cisplatin (CF), epirubicin, cisplatin and infused 5-FU (ECF) or docetaxel, cisplatin and 5-FU (DCF) regimens have been tested in clinical studies 6,[8][9][10][11][12][13] ; however, the additional survival advantage yielded by these combination therapies appears to be marginal. As a result, there is still no internationally accepted standard of care, and uncertainty remains regarding the choice of the regimen. Obviously, it is necessary to develop new active agents and combination regimens to achieve greater survival benefits in AGC.Irinotecan is a semisynthetic, water-soluble derivative of the plant alkaloid camptothecin. Following conversion to its active metabolite, SN-38, irinotecan acts by inhibiting DNA topoisomerase-I, thereby interfering with DNA replication and cell division. 14,15 In early phase trials in AGC, singleagent irinotecan administered every 2, 3 or 4 weeks demonstrates efficacy in both first-and second-line treatment settings with response rates of 18-23% 16-18 and 43.9-48% when combined with cisplatin. 19,20 Moreover, two published metaanalyses compari...

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“…Compared to the studies of Wagner et al 6 and Wang et al, 21 the number of eligible trials in this study was the most. However, this meta-analysis was still far from perfect.…”

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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

Qi¹,

Shen²,

Lin³

et al. 2012

Intl Journal of Cancer

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show abstract

“…A pooled analysis of four phase II and phase III trials on 657 patients treated with irinotecan-based regimens did not show any benefit in the overall survival and the overall response rate [12]. However, time to treatment failure was advantageous and patients treated with irinotecan showed less grade III-IV thombopenia.…”

Section: Treatmentmentioning

confidence: 99%

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

et al. 2011

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In 2010, the WHO introduced the seventh edition of the tumor node metastasis (TNM) classification that provides a more detailed classification for both local tumor invasion (T) and lymph node involvement (N) compared with the previous version. The T and N categories of tumors located in the stomach have been further modified with the intention to ensure a better correlation to the prognostic outcome. For the classification of a pN0, the number of lymph nodes has been adjusted to 16.The description of tumors with origin in the esophagus has been simplified and includes tumors of the esophagogastric junction as well as gastric tumors extending to the proximal 5 cm of the stomach. Major changes are further the subclassification of the categories T1 and T4 and the new N categorization now considering the number of lymph nodes involved within tree categories. Furthermore, positive lymph nodes in the region of the celiac trunc are considered as regional in case of esophageal cancers.The validity of the new classification system in its prognostic efficacy was compared to the previous edition. A study conducted in China proved a better prognostic stratification for the new actualized version [1]. Another study from Korea showed similar results for the new TNM system, proving a more detailed prognostic assessment, especially between T2 and T3 and N1 and N2 tumors [2]. The advantage of the new (7th) edition was mainly confirmed for the prognostic value of accurate lymph node assessment [3].Concerning the classification of early gastric cancer (GC) in the new system, a study from Italy confirmed the usefulness of the new classification for metastatic lymph nodes as a prognostic tool in case of early GC. AbstractThe validity and usefulness of the 7th edition of the UICC tumor node metastasis classification in the context of clinical management of gastric cancer are discussed. The most relevant new agent in gastric cancer therapy is trastuzumab for HER2-positive gastric carcinomas. This marks the success of continuous effort of translational research. Trastuzumab, initially applied in palliative settings, is currently being evaluated also in neoadjuvant treatment regimens. Several new meta-analyses support the carcinogenic effect of high salt intake and smoking in the context of Helicobacter pylori infection. Further data have become available on the efficacy of protective agents, acetyl salicylic acid ⁄ nonsteroidal anti-inflammatory drugs, and antioxidants. In search for a successful prevention strategy, the focus is on the identification of individuals at high risk who demand screening (testing) and surveillance. Serological assessment of gastric mucosal abnormalities with increased risk for gastric cancer development is extensively studied, and new data are presented from Asia as well as from Europe. New high-throughput techniques combined with bioinformatic vector analysis open the gate to the identification of new potential diagnostic and therapeutic targets. Furthermore, these approaches allow us to elucidate the int...

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“…The efficacy of CPT-11-based therapy versus non-CPT-11-based therapy was summarized in four meta-analyses [35, 51, 52, 59]. When it comes to OS, three of them demonstrated that the survival was statistically similar [51, 52, 59] while one meta-analysis favored CPT-11-containing therapy in terms of OS but the 1-year survival rate did not show significant difference between two groups [35].…”

Section: Resultsmentioning

confidence: 99%

“…When it comes to OS, three of them demonstrated that the survival was statistically similar [51, 52, 59] while one meta-analysis favored CPT-11-containing therapy in terms of OS but the 1-year survival rate did not show significant difference between two groups [35]. Additionally, statistically similar overall RR was observed in two meta-analyses [51, 52]. Another one found similar objective RR between two groups [35].…”

Section: Resultsmentioning

confidence: 99%

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

Liu

Wang

et al. 2016

Oncotarget

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This study aims to provide an overview of different treatment for advanced gastric cancer. In the present study, we systematically reviewed the major findings from relevant meta-analyses. A total of 54 relevant papers were searched via the PubMed, Web of Science, and Google scholar databases. They were classified according to the mainstay treatment modalities such as surgery, chemotherapy and others. Primary outcomes including overall survival, response rate, disease-free survival, recurrence-free survival, progression-free survival, time-to-progression, time-to failure, recurrence and safety were summarized. The recommendations and uncertainties regarding the treatment of advanced gastric cancer were also proposed. It was suggested that laparoscopic gastrectomy was a safe and technical alternative to open gastrectomy. Besides, neoadjuvant chemotherapy and adjuvant chemotherapy were thought to benefit the survival over surgery alone. And it was demonstrated in the study that targeted therapy like anti-angiogenic and anti-HER2 agents but anti-EGFR agent might have a significant survival benefit.

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Irinotecan-involved regimens for advanced gastric cancer: A pooled-analysis of clinical trials

Abstract: CPT-11-containing combination chemotherapy is advantageous over non CPT-11 -containing combination chemotherapy for TTF with no significant toxicity. CPT-11-containing combination chemotherapy can be used in treatment of advanced gastric cancer.

Cited by 10 publications

References 23 publications

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

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

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

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

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