Effectiveness and safety of oxaliplatin compared to cisplatin for advanced, unresectable gastric cancer: a systematic review and meta-analysis
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Francesco Montagnani Gina Turrisi Claudio Marinozzi Camillo Aliberti Giammaria Fiorentini
- چاپ و سال / کشور: 2011
Description
Background Cisplatin has been largely used in the treatment of advanced, unresectable gastric cancer, mainly in combinations with fluoropyrimidines and anthracyclines. Oxaliplatin has been shown to be at least as effective as cisplatin for this disease, but with less toxicity and a better tolerability profile, especially for older patients. We performed a systematic review of the literature to address and quantify differences in the efficacy and the safety between oxaliplatin and cisplatin for the treatment of this disease. Methods The literature was searched for randomized controlled trials (RCTs) comparing oxaliplatin to cisplatin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to analyze dichotomous variables. Hazard ratios (HRs) for progression and death were combined with an inverse variance method based on logarithmic conversion. A fixed effect model and Mantel–Haenszel’s (M-H) method were used. Heterogeneity was tested with the Q test and the I2 value. Sensitivity analyses were performed. Results Three RCTs were identified, involving a total of 1294 patients. Oxaliplatin significantly improved progression- free survival (HR = 0.88, p = 0.02) and overall survival (HR = 0.88, p = 0.04). Moreover, it was associated with less neutropenia (OR = 0.53, p\0.01) and fewer thromboembolic events (OR = 0.42, p\0.01), but it was also associated with increased neurotoxicity (OR = 6.91, p\0.01). Conclusions Our results support the existence of a small but significant survival benefit of oxaliplatin over cisplatin. Oxaliplatin is associated with less toxicity and better tolerability, especially in older patients and when used in twodrug, bi-weekly regimens
Gastric Cancer (2011) 14:50–55 DOI 10.1007/s10120-011-0007-7 Received: 10 August 2010 / Accepted: 26 September 2010 / Published online: 23 February 2011
