S-1 Versus Capecitabine in Treatment of Gastrointestinal Cancer: A Systematic Review and Meta-analysis / 胃肠病学

ABSTRACT

Background: S-1 and capecitabine are both the third generation oral fluoropyrimidine commonly used in the chemotherapy of gastrointestinal cancer. Numerous studies compared the efficacy and safety between these two drugs, but the results were not consistent. Aims: To compare the efficacy and safety of S-1 versus capecitabine in treatment of gastrointestinal cancer. Methods: A systematic literature review was conducted for clinical studies (in English) retrieved from PubMed, Embase, Web of Science and Cochrane Library. A meta-analysis was performed in eligible randomized controlled trials and retrospective studies comparing S-1 versus capecitabine for chemotherapy of gastric cancer and colorectal cancer using RevMan 5.3 software. Results: Thirteen studies with 3 540 gastric and colorectal cancer patients were identified for meta-analysis. In gastrointestinal cancer patients, the overall response rate (ORR), disease control rate (DCR) and overall survival (OS) of S-1 were not inferior to those of capecitabine (ORR OR=0.97, 95% CI 0.67-1.39, P=0.86; DCR OR=1.15, 95% CI 0.74-1.79, P=0.52; OS HR=0.96, 95% CI 0.91-1.01, P=0.15); subgroup analysis according to tumor location showed the same results. But for progression-free survival (PFS), S-1 was superior to capecitabine in overall patients (HR=0.94, 95% CI 0.89-0.98, P=0.008) and those with colorectal cancer (HR=0.93, 95% CI 0.88-0.98, P=0.004). Meta-analysis for adverse events indicated lower incidence of hand-food syndrome (grade 3-4 OR=0.07, 95% CI 0.04-0.13, P=0.000), and higher incidence of grade 3-4 leukopenia, constipation and diarrhea in S-1-based arm. Conclusions: S-1-based therapy might be recommended as a preferred alternative for fluoropyrimidine-based chemotherapy of gastric and colorectal cancer.