S-1 plus oxaloplation (S-1OX) versus capecitabine plus oxaloplation (CAPOX) for advanced gastric cancer: a systematic review and meta-analysis

Purpose Several therapeutic combinations are available for the treatment of advanced gastric cancer (AGC). It is unclear which combinations are most beneficial to the patients. The purpose of this study was to compare the efficacy and safety of Tegafur/ gimeracil/ oteracil (S-1) plus oxaliplation (S-1OX) with capecitabine plus oxaliplatin (CAPOX) in patients with AGC. Materials and Methods Relevant randomized controlled trials were searched in MEDLINE, EMBASE, The Cochrane Library (CENTRAL), two major Chinese biomedical databases (CBM, CNKI), and registry centers until July 22, 2019, with no language restrictions. Data were extracted for overall response rate (ORR), time to progression (TTP), overall survival time (OST), and toxicity. The systematic review was performed according to the recommendations of the Cochrane collaboration. RevMan 5.3.1 was used for statistical analysis. Results A total of 6 randomized controlled trials involving 911 patients were included. The quality of the trials was less than 3 points. All the trials demonstrated a significantly improved toxicity (hand-foot syndrome and neuropathy) in the S-1OX trials (p < 0.05). There was no statistically significant difference (p >0.05) between S-1OX versus CAPOX in terms of ORR, OST, TTP. Any of the subgroup analyses did not exhibit heterogeneity, so the fixed-effects model be used to execute the subgroup meta-analysis. Conclusions Both S-1OX and CAPOX showed similar efficacy for treatment of AGC. However, S1-OX appeared to present less toxicity in terms of hand-foot syndrome and neuropathy as compared to CAPOX.