Chunxiang Cao and Xunlei Zhang contributed equally to this work and share first authorship.
Survival benefit from S-1 as compared to Fluorouracil in Asian patients with advanced gastrointestinal cancer: A meta-analysis
Article first published online: 27 AUG 2014
© 2014 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Volume 105, Issue 8, pages 1008–1014, August 2014
How to Cite
Cancer Sci 105 (2014) 1008–1014
Funding information This study was supported by National Basic Science Research Development Program of China (2013CB911302); the Project of Plans for the Development of Science and Technology of Nanjing, China (201208020); the National Natural Science Foundation of China (81272469); the clinical special project for Natural Science Foundation of Jiangsu Province (BL2012016); and Nanjing 12th Five-Year key Scientific Project of medicine to Dr. Jinfei Chen.
- Issue published online: 27 AUG 2014
- Article first published online: 27 AUG 2014
- Accepted manuscript online: 28 JUN 2014 04:27AM EST
- Manuscript Accepted: 9 JUN 2014
- Manuscript Revised: 30 APR 2014
- Manuscript Received: 31 JAN 2014
- gastrointestinal cancer;
Whether S-1 could replace 5-Fluorouracil (5-Fu) or not in the treatment of advanced gastrointestinal (GI) cancer (including advanced gastric cancer [AGS] and metastatic colorectal cancer [mCRC]) in Asian patients has been controversial. This meta-analysis was performed to compare the activity, efficacy and toxicity of S-1-based versus 5-Fu-based chemotherapy in those Asian patients. Randomized controlled trials (RCTs) were identified by electronic search of Pubmed. Relevant abstracts were manually searched to identify relevant trials. A total of 2182 patients from eight RCTs were included, and our results demonstrated that S-1-based chemotherapy significantly improved overall survival (OS) (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.77–1.00) and overall response rate (ORR) (odds ratio [OR], 1.72; 95% CI, 1.09–2.70), but no significant progression-free survival (PFS) benefit was found between arms (HR, 0.87; 95% CI, 0.72–1.06). Subgroup analyses revealed that S-1-based chemotherapy significantly improved OS and ORR in subgroups of patients with non-platinum containing regimens (P = 0.041; P = 0.034) and patients with no prior chemotherapy history (P = 0.025; P = 0.016). Statistically significant improvements of PFS and ORR in the S-1-based chemotherapy were observed in the subgroup of patients with AGC (P < 0.001; P = 0.005). S-1-based chemotherapy was characterized by significantly higher incidences of diarrhea, fatigue and thrombocytopenia, and a lower incidence of nausea. This analysis provided strong evidence for survival benefits of S-1, and S-1-based chemotherapy could be considered to replace 5-Fu-based therapy for the treatment of advanced GI cancer in Asian patients.