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- Title
Meta-analysis of three randomized trials of capecitabine plus cisplatin (XP) versus S-1 plus cisplatin (SP) as first-line treatment for advanced gastric cancer.
- Authors
Nishikawa, Kazuhiro; Kawakami, Hisato; Shimokawa, Toshio; Fujitani, Kazumasa; Tamura, Shigeyuki; Endo, Shunji; Kobayashi, Michiya; Kawada, Junji; Kurokawa, Yukinori; Tsuburaya, Akira; Yoshikawa, Takaki; Sakamoto, Junichi; Satoh, Taroh
- Abstract
Background: S-1 plus cisplatin (SP) and capecitabine plus cisplatin (XP) are standard first-line regimens for advanced gastric cancer (AGC) worldwide. We conducted a meta-analysis using individual participant data (IPD) to investigate which is more suitable. Methods: IPD from three randomized trials were collected. In these trials, patients with AGC were randomly allocated to SP (S-1 80–120 mg for 21 days plus cisplatin 60 mg/m2 (q5w)) or XP (capecitabine 2000 mg/m2 for 14 days plus cisplatin 80 mg/m2 (q3w)). Results: In 211 eligible patients, median overall survival (OS) for SP versus XP was 13.5 and 11.7 months (hazard ratio [HR], 0.787; p = 0.114), progression-free survival (PFS) was 6.2 and 5.1 months (HR, 0.767; P = 0.076), and TTF was 5.1 and 4.0 months (HR, 0.611; P = 0.001). The most common grade ≥ 3 adverse events with SP or XP were neutropenia (18% vs. 29%) and anorexia (16% vs.18%). Subgroup analysis demonstrated significant interaction between treatment effect and performance status > 1 (HR, 0.685; P = 0.036), measurable lesion (HR, 0.709; P = 0.049), primary upper third tumor (HR, 0.539; P = 0.040), and differentiated type (HR, 0.549; interaction, 0.236; P = 0.019). For the differentiated type, OS was significantly longer in the SP group (13.2 months) than in the XP group (11.1 months) (HR, 0.549; P = 0.019). For the undifferentiated type, OS was similar in the SP group (14.2 months) and in the XP group (12.4 months) (HR, 0.868; P = 0.476). Conclusions: SP and XP were both effective and well tolerated. SP might be suitable for the pathological differentiated subtype of AGC. Clinical Trial Registration: The HERBIS-2, HERBIS-4A, and XParTS II trials were registered with UMIN-CTR as UMIN000006105, UMIN000006755, and UMIN000006045, respectively.
- Subjects
STOMACH cancer; CISPLATIN; PROGRESSION-free survival
- Publication
International Journal of Clinical Oncology, 2023, Vol 28, Issue 11, p1501
- ISSN
1341-9625
- Publication type
Article
- DOI
10.1007/s10147-023-02402-1