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Third-line systemic treatment versus best supportive care for advanced/metastatic gastric cancer: A systematic review and meta-analysis

Critical Reviews in Oncology/Hematology, August 2017, Volume 116, Pages 68-81



  • This review looks exclusively into metastatic gastric patients who failed second-line treatment.

  • All participants used study medications in third-line setting.

  • Third-line systemic therapies showed superior efficacy in OS, PFS, ORR and DCR.

  • More toxicities (both all grades and high grade) occurred in patients on third-line therapies.

  • Future studies should focus more on the QOL-related outcomes in third-line setting.



This review evaluated the efficacy, toxicities and quality of life of third-line systemic treatment (TLT) versus best supportive care (BSC) in metastatic gastric cancer patients after failing two lines of systemic treatment.

Six studies were included, involving 890 participants (TLT: 587, BSC: 303, Asian: 679, 76.3%), median 53–61 years old, ECOG 0–1 with no major co-morbidities. Compared with BSC, TLT improved overall survival (HR 0.63; 95% CI 0.46–0.87, corresponding to an improvement in medial OS from 3.20 to 4.80 months), progression-free survival (HR 0.29; 95% CI 0.18–0.45), objective response rate (RR 5.28; 95% CI 1.00–27.83) and disease control rate (RR 4.51; 95% CI 2.64–7.71). The efficacy results favoring TLT should be interpreted with caution for the substantial heterogeneities, wide confidence intervals and selection bias. More toxicities occurred in the TLT arms.

This review highlighted the paucity of QOL data. Future studies should focus more on QOL-related outcomes. PROSPERO registration: 2015 CRD42015017873.

Keywords: Gastric cancer, Metastatic, Chemotherapy, Targeted therapy, Palliative care.