The efficacy and toxicity of paclitaxel plus S-1 compared with paclitaxel plus 5-Fu for advanced gastric cancer: A PRISMA systematic review and meta-analysis of randomized controlled trials

Abstract

The standard treatment for patients with advanced gastric cancer (AGC) is still a matter of debate. The chemotherapy regimen of paclitaxel (PTX) combined with S-1 has been used to treat AGC or metastatic gastric cancer. We conducted a meta-analysis to compare oral S-1 and infusional 5-fluorouracil (5-FU) to determine which agent was more efficacious and less toxic in combination with PTX. A systematic review with a metaanalysiswas performed. PubMed,EmBase, theCochraneCentralRegister of Controlled Trials, and the China National Knowledge Infrastructure databases were searched to select randomized controlled trials (RCTs) comparing PTX plus S-1 and PTX plus 5-FU in patients with AGC. Three RCTs were eligible and 352 patients were analyzed. PTX plus S-1 increased the disease control rate (risk ratio [RR]=1.14, 95% confidence interval [CI]=1.00-1.30, P=0.04) and reduced the progressive disease rate (RR=0.62, 95% CI]=0.39-0.98, P=0.04) compared with PTX plus 5-FU. There was a significant decrease in nausea (RR=0.60, 95% CI=0.43-0.82, P=0.001) and vomiting (RR=0.55, 95% CI=0.33-0.91, P=0.02) in patients treated with PTX plus S-1. PTX plus S-1 was associated with almost equivalent safety and a lower progressive disease rate compared with PTX plus 5-FU. PTX plus S-1 is a good alternative strategy for patients who cannot tolerate a continuous intravenous infusion.