Third-line chemotherapy in advanced gastric cancer: A systematic review and meta-analysis

BACKGOUND: Little information regarding to the survival advantage of third-line chemotherapy in advanced gastric cancer patients is available. The current study is designed to systematically review and perform meta-analysis on the effect of third-line chemotherapy on progressive or recurrent gastric cancer treatment. METHODS: After thorough searching of online databases, total 20 articles were included into qualitative systematic review and 6 of them were used to conduct qualitative meta-analysis. RESULTS: It was found that the third-line chemotherapy was superior to placebo or best supportive care in terms of prolonging median oval survival (OS) length and progress free survival (PFS) length (Hedges's g for OS = −0.315 ± 0.077, P < .001; and for PFS = −0.382 ± 0.098, P < .001). In addition, the third-line chemotherapy was favored (Hedges's g = 0.848, P < .001) in terms of overall survival rate (Hazard ratio = 0.679, 95% confidence interval: 0.565–0.816, P < .001) or tumor free survival rate (Hazard ratio = 0.561, 95% confidence interval: 0.444–0.709, P < .001). CONCLUSION: The third-line chemotherapy is superior to the best supportive care in advanced gastric cancer patients who had been pretreated with first-line and second-line chemotherapy.