Cochrane · systematic review · CD004064
Chemotherapy for advanced gastric cancer
Wagner, AD, Syn, NLX, Moehler, M, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
GutAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
61
current version
GRADE rated
61
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 17 · 27.9%Low 16 · 26.2%Moderate 20 · 32.8%High 8 · 13.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Chemotherapy versus best supportive care for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Chemotherapy vs best supportive care | HR 0.37 [0.24, 0.55] | 3 studies · 184 participants | Moderate Downgraded: risk of bias |
Time to progression Chemotherapy vs best supportive care | HR 0.31 [0.22, 0.43] | 2 studies · 144 participants | Moderate Downgraded: risk of bias |
Combination versus single‐agent chemotherapy for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Combination vs single‐agent chemotherapy | HR 0.84 [0.79, 0.89] | 23 studies · 4447 participants | Moderate Downgraded: risk of bias |
Tumour response Combination vs single‐agent chemotherapy | OR 2.3 [1.94, 2.72] | 18 studies · 2833 participants | High |
Time to progression Combination vs single‐agent chemotherapy | HR 0.69 [0.55, 0.87] | 4 studies · 720 participants | Moderate Downgraded: risk of bias |
Treatment‐related death Combination vs single‐agent chemotherapy | OR 1.64 [0.83, 3.24] | 18 studies · 3876 participants | Moderate Downgraded: imprecision |
5‐FU/cisplatin/anthracycline combinations versus 5‐FU/cisplatin combinations (without anthracyclines) for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival 5‐FU/cisplatin/anthracycline combinations vs 5‐FU/cisplatin combinations (without anthracyclines) | HR 0.74 [0.61, 0.89] | 4 studies · 579 participants | Moderate Downgraded: risk of bias |
Tumour response 5‐FU/cisplatin/anthracycline combinations vs 5‐FU/cisplatin combinations (without anthracyclines) | OR 2.86 [1.14, 7.16] | 1 study · 78 participants | Low Downgraded: imprecision |
Time to progression 5‐FU/cisplatin/anthracycline combinations vs 5‐FU/cisplatin combinations (without anthracyclines) | HR 0.62 [0.38, 0.98] | 1 study · 78 participants | Low Downgraded: imprecision |
5‐FU/cisplatin/anthracycline combinations versus 5‐FU/anthracycline combinations (without cisplatin) for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival 5‐FU/cisplatin/anthracycline combinations vs 5‐FU/anthracycline combinations (without cisplatin) | HR 0.82 [0.73, 0.92] | 7 studies · 1147 participants | Low Downgraded: risk of bias, inconsistency |
Irinotecan versus non‐irinotecan‐containing regimens for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Irinotecan vs non‐irinotecan‐containing regimens | HR 0.87 [0.8, 0.95] | 10 studies · 2135 participants | Moderate Downgraded: risk of bias |
Overall survival ‐ Substitutive comparisons Irinotecan vs non‐irinotecan‐containing regimens | HR 0.87 [0.75, 1] | 6 studies · 826 participants | Moderate Downgraded: risk of bias |
Overall survival ‐ Additive comparisons Irinotecan vs non‐irinotecan‐containing regimens | HR 0.88 [0.76, 1.03] | 3 studies · 500 participants | Low Downgraded: risk of bias, imprecision |
Overall survival ‐ Other comparisons Irinotecan vs non‐irinotecan‐containing regimens | HR 0.87 [0.76, 1] | 2 studies · 809 participants | Very low Downgraded: risk of bias, inconsistency |
Tumour response Irinotecan vs non‐irinotecan‐containing regimens | OR 1.72 [1.24, 2.4] | 10 studies · 1266 participants | Low Downgraded: inconsistency |
Tumour response ‐ Substitutive comparisons Irinotecan vs non‐irinotecan‐containing regimens | OR 1.53 [0.93, 2.5] | 6 studies · 756 participants | Low Downgraded: inconsistency |
Tumour response ‐ Additive comparisons Irinotecan vs non‐irinotecan‐containing regimens | OR 2.18 [1.25, 3.8] | 3 studies · 345 participants | Low Downgraded: risk of bias, imprecision |
Tumour response ‐ Other comparisons Irinotecan vs non‐irinotecan‐containing regimens | OR 1.87 [0.89, 3.91] | 2 studies · 165 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Progression‐free survival Irinotecan vs non‐irinotecan‐containing regimens | HR 0.76 [0.69, 0.84] | 7 studies · 1640 participants | High |
Progression‐free survival ‐ Substitutive comparison Irinotecan vs non‐irinotecan‐containing regimens | HR 0.85 [0.72, 1] | 5 studies · 741 participants | Moderate Downgraded: risk of bias |
Progression‐free survival ‐ Additive comparisons Irinotecan vs non‐irinotecan‐containing regimens | HR 0.51 [0.33, 0.77] | 1 study · 90 participants | Moderate Downgraded: imprecision |
Progression‐free survival ‐ Other comparisons Irinotecan vs non‐irinotecan‐containing regimens | HR 0.74 [0.66, 0.84] | 2 studies · 809 participants | High |
Treatment‐related death Irinotecan vs non‐irinotecan‐containing regimens | OR 0.88 [0.23, 3.32] | 9 studies · 1979 participants | Low Downgraded: imprecision, inconsistency |
Treatment discontinuation due to toxicity Irinotecan vs non‐irinotecan‐containing regimens | OR 1 [0.46, 2.2] | 9 studies · 1979 participants | Very low Downgraded: imprecision, inconsistency |
Docetaxel versus non‐docetaxel‐containing regimens for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Docetaxel vs non‐docetaxel‐containing regimens | HR 0.86 [0.78, 0.95] | 8 studies · 2001 participants | High |
Overall survival ‐ Substitutive comparisons Docetaxel vs non‐docetaxel‐containing regimens | HR 1.05 [0.87, 1.27] | 3 studies · 479 participants | Moderate Downgraded: imprecision |
Overall survival ‐ Additive comparisons Docetaxel vs non‐docetaxel‐containing regimens | HR 0.8 [0.71, 0.91] | 4 studies · 1466 participants | Moderate Downgraded: risk of bias |
Overall survival ‐ Other comparisons Docetaxel vs non‐docetaxel‐containing regimens | HR 0.8 [0.46, 1.39] | 1 study · 56 participants | Very low Downgraded: risk of bias, imprecision |
Tumour response Docetaxel vs non‐docetaxel‐containing regimens | OR 1.37 [1.03, 1.83] | 9 studies · 1820 participants | Moderate Downgraded: inconsistency |
Tumour response ‐ Substitutive comparison Docetaxel vs non‐docetaxel‐containing regimens | OR 1.03 [0.71, 1.5] | 4 studies · 525 participants | Moderate Downgraded: imprecision |
Tumour response ‐ Additive comparison Docetaxel vs non‐docetaxel‐containing regimens | OR 1.83 [1.45, 2.32] | 4 studies · 1235 participants | High |
Tumour response ‐ Other comparison Docetaxel vs non‐docetaxel‐containing regimens | OR 0.33 [0.12, 0.96] | 1 study · 60 participants | Very low Downgraded: imprecision |
Time to progression Docetaxel vs non‐docetaxel‐containing regimens | HR 1.06 [0.85, 1.32] | 2 studies · 360 participants | Very low Downgraded: risk of bias, imprecision |
Progression‐free survival Docetaxel vs non‐docetaxel‐containing regimens | HR 0.76 [0.63, 0.91] | 5 studies · 1498 participants | Moderate Downgraded: inconsistency |
Progression‐free survival ‐ Substitutive comparisons Docetaxel vs non‐docetaxel‐containing regimens | HR 1.15 [0.77, 1.72] | 1 study · 119 participants | Very low Downgraded: risk of bias, imprecision |
Progression‐free survival ‐ Additive comparison Docetaxel vs non‐docetaxel‐containing regimens | HR 0.7 [0.61, 0.81] | 3 studies · 1323 participants | High |
Progression‐free survival ‐ Other comparison Docetaxel vs non‐docetaxel‐containing regimens | HR 0.94 [0.55, 1.6] | 1 study · 56 participants | Very low Downgraded: imprecision |
Treatment‐related death Docetaxel vs non‐docetaxel‐containing regimens | OR 1.1 [0.55, 2.2] | 7 studies · 2113 participants | Moderate Downgraded: imprecision |
Treatment discontinuation due to toxicity Docetaxel vs non‐docetaxel‐containing regimens | OR 0.81 [0.53, 1.25] | 5 studies · 1066 participants | Low Downgraded: imprecision, inconsistency |
Capecitabine versus 5‐FU‐containing regimens for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall Survival Capecitabine vs 5‐FU‐containing regimens | HR 0.94 [0.79, 1.11] | 5 studies · 732 participants | Moderate Downgraded: risk of bias |
Tumour response Capecitabine vs 5‐FU‐containing regimens | OR 0.85 [0.4, 1.79] | 4 studies · 636 participants | Very low Downgraded: imprecision, inconsistency |
Time to progression Capecitabine vs 5‐FU‐containing regimens | HR 0.72 [0.47, 1.12] | 1 study · 85 participants | Very low Downgraded: risk of bias, imprecision |
Progression‐free survival Capecitabine vs 5‐FU‐containing regimens | HR 0.98 [0.77, 1.23] | 4 studies · 647 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Treatment‐related death Capecitabine vs 5‐FU‐containing regimens | OR 1.88 [0.23, 15.15] | 2 studies · 481 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Treatment discontinuation due to toxicity Capecitabine vs 5‐FU‐containing regimens | OR 0.99 [0.56, 1.77] | 1 study · 311 participants | Low Downgraded: imprecision |
Oxaliplatin versus the same regimen including cisplatin for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall Survival Oxaliplatin vs the same regimen including cisplatin | HR 0.81 [0.67, 0.98] | 5 studies · 1105 participants | Low Downgraded: risk of bias, inconsistency |
Tumour response Oxaliplatin vs the same regimen including cisplatin | OR 1.38 [1.08, 1.76] | 5 studies · 1081 participants | Moderate Downgraded: risk of bias |
Progression‐free survival Oxaliplatin vs the same regimen including cisplatin | HR 0.88 [0.66, 1.19] | 4 studies · 1034 participants | Low Downgraded: risk of bias, imprecision |
Treatment‐related death Oxaliplatin vs the same regimen including cisplatin | OR 0.47 [0.17, 1.3] | 5 studies · 1132 participants | Low Downgraded: risk of bias, imprecision |
Treatment discontinuation due to toxicity Oxaliplatin vs the same regimen including cisplatin | OR 0.97 [0.44, 2.13] | 3 studies · 970 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Taxane‐platinum‐fluoropyrimidine combinations versus taxane‐platinum (without fluoropyrimidine) for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival Taxane‐platinum‐fluoropyrimidine combinations vs taxane‐platinum (without fluoropyrimidine) | OR 0.86 [0.71, 1.06] | 3 studies · 482 participants | Very low Downgraded: risk of bias, inconsistency |
Tumour response Taxane‐platinum‐fluoropyrimidine combinations vs taxane‐platinum (without fluoropyrimidine) | OR 2.08 [1.37, 3.15] | 3 studies · 482 participants | Low Downgraded: risk of bias, imprecision |
Progression‐free survival Taxane‐platinum‐fluoropyrimidine combinations vs taxane‐platinum (without fluoropyrimidine) | OR 0.74 [0.59, 0.93] | 3 studies · 482 participants | Moderate Downgraded: risk of bias |
Treatment‐related death Taxane‐platinum‐fluoropyrimidine combinations vs taxane‐platinum (without fluoropyrimidine) | OR 1.95 [0.73, 5.17] | 3 studies · 482 participants | Very low Downgraded: risk of bias, imprecision |
Treatment discontinuation due to toxicity Taxane‐platinum‐fluoropyrimidine combinations vs taxane‐platinum (without fluoropyrimidine) | OR 1.71 [0.79, 3.69] | 2 studies · 234 participants | Very low Downgraded: risk of bias, imprecision |
S‐1 versus 5‐FU‐containing regimens for advanced gastric cancer
Population: people with advanced gastric cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall Survival S‐1 vs 5‐FU‐containing regimens | HR 0.91 [0.83, 1] | 4 studies · 1793 participants | High |
Tumour response S‐1 vs 5‐FU‐containing regimens | OR 1.73 [1.01, 2.94] | 7 studies · 1753 participants | Very low Downgraded: imprecision, inconsistency |
Progression‐free survival S‐1 vs 5‐FU‐containing regimens | HR 0.85 [0.7, 1.04] | 4 studies · 1942 participants | Low Downgraded: inconsistency |
Time‐to treatment failure S‐1 vs 5‐FU‐containing regimens | HR 0.88 [0.76, 1.01] | 5 studies · 1818 participants | Low Downgraded: inconsistency |
Treatment‐related deaths S‐1 vs 5‐FU‐containing regimens | OR 0.56 [0.3, 1.06] | 4 studies · 1962 participants | Moderate Downgraded: imprecision |
Treatment discontinuation due to toxicity S‐1 vs 5‐FU‐containing regimens | OR 0.85 [0.63, 1.13] | 3 studies · 1726 participants | High |