Cisplatin plus 5-fluorouracil/leucovorin versus oxaliplatin plus 5-fluorouracil/leucovorin in the treatment of advanced gastric cancer: a systematic review

AIM: To assess the efficacy of FOLFOX chemotherapy [oxaliplatin plus 5-fluorouracil (5-FU)/leucovorin (LV)] for advanced gastric cancer through a meta-analysis of randomized controlled trials (RCTs) published worldwide in English or Chinese. METHODS: Cochrane strategy in combination with manual search was used to identify previously published randomized controlled trials by searching Cochrane library, PubMed, EMBase, Chinese Biomedical Literature Database (CBM), China Journal Full-text Database, and Chinese Scientific Journal Full-text Database (CSJD). RESULTS: Eight randomized controlled trials involving a total of 662 patients were studied. Of the eight trials, 7 were performed in China, and 1 in the United States. Evaluation of the method-ological quality showed that the eight RCTs had a moderate risk of bias. Although no statistical difference was found in the 1-year survival rate OR = 1.37, 95% confidence interval (95%CI) = [0.93-2.01] between patients treated with oxaliplatin plus 5-FU/LV and cisplatin plus 5-FU/LV, there was a signifi cant difference in the overall survival rate between the two groups of patients (OR = 1.93, 95%CI = 1.41-2.66). The incidences of grade 3/4 side effects such as leucopenia and nausea and vomiting were slightly lower in patients treated with oxaliplatin plus 5-FU/LV than in those treated with cisplatin plus 5-FU/ LV (OR = 0.48 and 0.26, 95%CI = 0.28-0.83 and 0.16-0.42, respectively). In contrast, the incidence of peripheral neurotoxicity was higher in patients treated with oxaliplatin plus 5-FU/LV than in those treated with cisplatin plus 5-FU/ LV (OR = 1.20, 95%CI = 0.44-3.30). No significant difference was noted in the incidence of thrombocytopenia between the two groups of patients (OR = 7.38, 95%CI = 2.16-25.23). CONCLUSION: Oxaliplatin plus 5-FU/LV is superior to cisplatin plus 5-FU/LV in improving overall survival rate, but not 1-year survival rate and median survival time. The incidences of nausea and vomiting and leucopenia are lower in patients treated with oxaliplatin plus 5-FU/ LV than in those treated with cisplatin plus 5-FU/LV.