Meta-Analysis Of Irinotecan Monotherapy Versus Irinotecan-Based Combined Second-Line Therapy For The Treatment Of Advanced Gastric Cancer

For advanced gastric cancer patients who have recurrence and metastasis after having received first-line chemotherapy, effective and reasonable second-line chemotherapy can extend the survival time and improve the quality of life. Irinotecan has been confirmed to be an effective second-line chemotherapy drug for advanced gastric cancer. However, the specific regimen remains controversial. Through meta-analysis, this study compared the efficacy and safety of irinotecan monotherapy and irinotecan-based combined therapy. Relevant literature was retrieved from the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases. Data were arranged and classified according to the traditional format. The outcome measures were OS (overall survival), PFS (progressive free survival), ORR (overall response rate), DCR (disease control rate), and grade 3-4 adverse events. Compared to irinotecan monotherapy, irinotecan-based combined therapy could significantly increase PFS (HR 0.78, 95% CI 0.63-0.98; P=0.03) and DCR (OR=1.62; 95% CI 1.10-2.37; P=0.01). However, there was no significant difference in OS (HR 0.89, 95% CI 0.71-1.11; P=0.31) and ORR (OR=1.55; 95% CI 0.94-2.55; P=0.09). In addition, pooled data revealed no significant difference in safety profiles for both grade 3/4 hematologic and grade 3/4 non-hematological events between the two groups. Treatment of advanced gastric cancer using irinotecan (CPT-11)-based second-line thermotherapy could significantly prolong PFS and increase DCR of patients. In addition, compared to irinotecan monotherapy, this combined therapy did not significantly increase serious toxic side effects of chemotherapy. Therefore, we recommend irinotecan-based combined chemotherapy as the second-line thermotherapy regimen for advanced gastric cancer.