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Published in: Gastric Cancer 3/2012

01-07-2012 | Original article

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

Authors: Chiun Hsu, Ying-Chun Shen, Chia-Chi Cheng, Ann-Lii Cheng, Fu-Chang Hu, Kun-Huei Yeh

Published in: Gastric Cancer | Issue 3/2012

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Abstract

Background

The standard of chemotherapy regimens for advanced or metastatic gastric cancer and the clinical outcome were heterogeneous in Asian versus non-Asian countries. This study aimed to explore predictors of safety and efficacy of chemotherapy for patients with advanced or metastatic gastric cancer.

Methods

Treatment group-based meta-analysis and meta-regression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines.

Results

Twenty-five trials (8 Asian, 17 Western or international) with 56 treatment groups were analyzed. Asian trials reported a lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffuse-type histology, and more frequent use of second-line chemotherapy. Meta-analysis revealed significant heterogeneity both in treatment safety (grade 3–4 neutropenia and diarrhea) and efficacy [6-month progression-free survival (PFS) and 1-year overall survival (OS)]. Meta-regression analyses indicate that Asian trials are associated with an 8.2% lower incidence of grade 3–4 neutropenia and 2.1% lower incidence of grade 3–4 diarrhea. A lower percentage of patients with gastroesophageal junction carcinoma and the use of combination regimens predicted better PFS. The use of second-line chemotherapy predicts better 1-year OS, which will increase by 10% for every 10% increase in patients who received second-line chemotherapy.

Conclusion

Geographic region (Asian vs. non-Asian) is an independent predictor of safety in systemic therapy for gastric cancer.
Appendix
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Metadata
Title
Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression
Authors
Chiun Hsu
Ying-Chun Shen
Chia-Chi Cheng
Ann-Lii Cheng
Fu-Chang Hu
Kun-Huei Yeh
Publication date
01-07-2012
Publisher
Springer Japan
Published in
Gastric Cancer / Issue 3/2012
Print ISSN: 1436-3291
Electronic ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-011-0106-5

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