Efficacy and safety of paclitaxel-based therapy and nonpaclitaxel-based therapy in advanced gastric cancer

Aim: To compare the efficacy and safety of paclitaxel-based therapy versus nonpaclitaxel-based therapy in patients with advanced gastric cancer (AGC). Methods: An adequate literature search in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, American Society of Clinical Oncology and European Society of Medical Oncology was conducted. Phase II/III randomized controlled trials that detected the efficacy and safety of paclitaxel-based therapy and nonpaclitaxel-based therapy in AGC patients were enrolled. Overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events were included in the endpoints. Results: A total of 632 patients in seven studies of were reviewed. There was a significant difference in ORR between paclitaxel and placebo therapy (odd ratio [OR] =2.68, 95% confidence interval [CI] = 1.05–6.86, P = 0.04), but not between paclitaxel and irinotecan, cisplatin or docetaxel. As no first-line treatment, paclitaxel-based therapy significantly increased ORR (OR = 1.55, 95% CI = 1.02–2.34, P = 0.04, I2 = 0%). No significant differences were found in PFS and OS between paclitaxel- and nonpaclitaxel-based therapies. In addition, paclitaxel-based therapy generally decreased the risk of vomiting and stomatitis while increased the risks of leukopenia and sensory neuropathy. Conclusion: Paclitaxel-based therapy improved ORR in AGC patients as no first-line therapy, but no significant difference was observed for PFS and OS.