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Chemotherapy for Gastric Cancer: Hold the Anthracycline and Spare the Taxane
Standard chemotherapy for esophageal and gastroesophageal junction adenocarcinoma mirrors that for gastric cancer and typically combines a fluorinated pyrimidine with a platinum agent, yet there is ongoing controversy about the relative benefit of triplet versus doublet chemotherapy and whether or not anthracyclines should be included in combination chemotherapy regimens.
Investigators now report the results of a network meta-analysis of the safety and efficacy of first-line chemotherapy for esophagogastric cancer. The analysis evaluated 17 chemotherapy regimens received by more than 10,000 patients in 50 studies, including 34 that directly compared chemotherapy regimens in nearly 7800 patients.
Pooled direct and indirect comparisons indicated the following:
- Overall survival (OS) was superior for noncisplatin- versus cisplatin-containing doublet regimens, including irinotecan/fluoropyrimidine versus cisplatin/fluoropyrimidine (hazard ratio, 0.85) and oxaliplatin/fluoropyrimidine versus cisplatin/ fluoropyrimidine (HR, 0.83).
- Progression-free survival (PFS) was also superior for oxaliplatin/fluoropyrimidine versus cisplatin/fluoropyrimidine (HR, 0.66).
- OS and PFS were not improved by adding an anthracycline to fluorinated pyrimidine/platinum.
- Regarding the addition of a taxane to fluorinated pyrimidine/platinum combination therapy, both PFS and OS benefits were seen only for the addition of a taxane to oxaliplatin/fluorinated pyrimidine chemotherapy.
- Cisplatin/fluoropyrimidine was more toxic than noncisplatin-containing doublets; taxane triplet regimens also caused excess nausea and hematologic toxicities.
Comment
This contemporary meta-analysis underscores results of recent phase III trials indicating that oxaliplatin/fluorinated pyrimidine doublet chemotherapy is the emerging global standard of care for the treatment of advanced esophagogastric cancer. Adding an anthracycline to two drug regimens fails to improve outcome. Adding a taxane to two-drug therapy may improve outcome, but use of these regimens will likely be limited to younger and high-function patients capable of tolerating higher toxicity.
Citation(s)
Author:
ter Veer E et al.
Title:
The efficacy and safety of first-line chemotherapy in advanced esophagogastric cancer: A network meta-analysis.
Source:
J Natl Cancer Inst
2016
Aug
30; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David H. Ilson, MD, PhD