by ecancer reporter Janet Fricker

In advanced gastric cancer chemotherapy improves survival by an additional 6.7 months in comparison to best supportive care (BSC) and combination chemotherapy improves survival by an additional month compared to single agent 5-FU, concluded a Cochrane review.

Gastric cancer is the fifth most common cancer worldwide, with 80 to 90% of patients in countries where screening is not routine either diagnosed at an advanced stage (when tumours are inoperable) or developing a recurrence within five years of surgery.

In the review, the Cochrane Upper GI and Pancreatic Diseases Group assessed the efficacy of chemotherapy versus BSC, combination versus single-agent chemotherapy and different chemotherapy combinations in advanced gastric cancer.

The authors, led by Anna Dorothea Wagner, included 64 randomised controlled trials (RCTs), of which 60 studies (with 11,698 participants) contained data on overall survival.

Results showed:

• Chemotherapy extends overall survival (OS) by approximately 6.7 months more than BSC (HR 0.3; 95% CI 0.24 to 0.55), (184 participants, three studies, moderate quality evidence).
• Combination chemotherapy extends OS by an additional month versus single-agent chemotherapy (HR 0.84; 95% CI 0.79 to 0.89) (4447 participants, 23 studies, moderate-quality evidence).
• Gains were partly counterbalanced by increased toxicity.
• Irinotecan extends OS by an additional 1.6 months versus non-irinotecan-containing regimens (HR 0.87; 95% CI 0.80 to 0.95) (2135 participants, 10 studies, high-quality evidence).
• Docetaxel extends OS by just over one month compared to non-docetaxel-containing regimens (HR 0.86, 95% CI 0.78 to 0.95) (2001 participants, eight studies, high-quality evidence). 
• Oxaliplatin may extend OS by less than one month versus cisplatin-containing regimens (HR 0.81; 95% CI 0.67 to 0.98) (1105 participants, five studies, low-quality evidence).

“Testing all patients for HER-2 status may help to identify patients with HER-2-positive tumours, for whom, in the absence of contraindications, trastuzumab in combination with capecitabine or 5-FU in combination with cisplatin has been shown to be beneficial,” write the authors.

“For HER-2 negative people, all different two-and three-drug combinations including irinotecan, docetaxel, oxaliplatin or oral 5-FU prodrugs are valid treatment options for advanced gastric cancer, and consideration of the side effects of each regimen is essential in the treatment decision.”

Source: Cochrane Library