Department of Oncology, Affiliated Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.
World J Gastroenterol. 2010 Dec 14;16(46):5889-94. doi: 10.3748/wjg.v16.i46.5889.
To assess the efficiency and toxicities of irinotecan (CPT-11)-involved regimens in patients with advanced gastric cancer.
Randomized phases II and III clinical trials on chemotherapy for advanced gastric cancer were searched from MEDLINE, EMbase, Cochrane Controlled Trials Register, and EBSCO. Relevant abstracts were manually searched. A total of 657 patients were analyzed for their overall response rate (ORR), time to treatment failure (TTF), overall survival (OS) rate, and toxicities. Overall survival rate, reported as hazard ratio (HR) with 95% CI, was used as the primary outcome measure.
Four randomized controlled trials on chemotherapy for advanced gastric cancer were detected. The CPT-11-containing combination chemotherapy was not significantly advantageous over the non CPT-11-containing combination chemotherapy for OS rate (HR = 1.12, 95% CI: 0.92-1.36, P = 0.266) and ORR [risk ratio (RR) = 1.23, 95% CI: 0.71-2.14, P = 0.458]. However, the CPT-11-containing combination chemotherapy was significantly advantageous over the non CPT-11-containing combination chemotherapy for TTF (HR = 1.35, 95% CI: 1.12-1.64, P = 0.002). Grade 3/4 haematological toxicity (thrombocytopenia: RR = 0.20, 95% CI: 0.09-0.48; P < 0.001) and gastrointestinal toxicity (diarrhea: RR = 4.09, 95% CI: 2.42-6.93, P < 0.001) were lower in patients with advanced gastric cancer after CPT-11-containing combination chemotherapy than after non CPT-11 -containing combination chemotherapy.
CPT-11-containing combination chemotherapy is advantageous over non CPT-11 -containing combination chemotherapy for TTF with no significant toxicity. CPT-11-containing combination chemotherapy can be used in treatment of advanced gastric cancer.
评估伊立替康（CPT-11）相关方案在晚期胃癌患者中的疗效和毒性。
从 MEDLINE、EMbase、Cochrane 对照试验注册库和 EBSCO 中检索晚期胃癌化疗的随机 II 期和 III 期临床试验。手动检索相关摘要。对 657 名患者的总缓解率（ORR）、治疗失败时间（TTF）、总生存率（OS）和毒性进行分析。OS 率，报告为风险比（HR）和 95%CI，作为主要终点。
检测到 4 项晚期胃癌化疗的随机对照试验。CPT-11 联合化疗在 OS 率（HR=1.12，95%CI：0.92-1.36，P=0.266）和 ORR[风险比（RR）=1.23，95%CI：0.71-2.14，P=0.458]方面并未显著优于非 CPT-11 联合化疗。然而，CPT-11 联合化疗在 TTF 方面显著优于非 CPT-11 联合化疗（HR=1.35，95%CI：1.12-1.64，P=0.002）。晚期胃癌患者接受 CPT-11 联合化疗后，3/4 级血液学毒性（血小板减少症：RR=0.20，95%CI：0.09-0.48；P<0.001）和胃肠道毒性（腹泻：RR=4.09，95%CI：2.42-6.93，P<0.001）低于非 CPT-11 联合化疗。
CPT-11 联合化疗在 TTF 方面优于非 CPT-11 联合化疗，且毒性无显著增加。CPT-11 联合化疗可用于治疗晚期胃癌。
