Recent research compared the efficacy of chemotherapy vs best supportive care, combination vs single-agent chemotherapy, and multiple different chemotherapy combinations in advanced gastric cancer (doi:10.1002/14651858.CD004064.pub4).
In patients with advanced gastric cancer, significant benefits from targeted therapies are limited to HER2-positive disease. Systemic chemotherapy is the current standard of treatment. However, the optimal choice of regimen in the first- and second-line setting remains uncertain.
A group of international researchers led by Anna Dorothea Wagner, MD, Lausanne University Hospitals and Clinics (Switzerland), conducted a study to assess the effectiveness of various chemotherapy regimens in advanced gastric cancer. A total of 60 randomized controlled trials with 11,698 participants with data on overall survival were identified from various biomedical databases that tested systemic, intravenous or oral chemotherapy versus best supportive care; combination versus single-agent chemotherapy; or different chemotherapy regimens in advanced disease.
After a complete analysis of all the data, researchers determined that chemotherapy improves survival by approximately 6.7 months, as well as quality of life, compared with best supportive care alone. First-line combination chemotherapy also improves survival (by approximately 1 month) compared to single-agent fluorouracil.
Additionally, researchers reported that while docetaxel plus platinum-fluoropyrimidine-based chemotherapy regimens are documented to extend survival by just over 1 additional month, increased toxicity is noted as a result of this regimen. Any additional benefit of including a third drug (docetaxel or epirubicin) to a two-drug platinum-fluoropyrimidine chemotherapy combination in an effort to outweigh its toxicity is unclear with the current evidence.
Researchers concluded that when choosing a regimen to treat advanced gastric cancer, the known side effects and the impact of these side effect on the individual’s quality of life, as well as the tumor burden and necessity to obtain a rapid response, are important factors to consider.—Zachary Bessette