The Efficacy Of Molecular Targeted Agents In The Treatment Of Gastroesophageal Junction Cancer: A Systematic Review And Meta-Analysis

During the past decades, several prospective trials have been conducted to assess the efficacy of molecular targeted agents (MTAs) in the treatment of gastroesophageal junction (GEJ) carcinoma, but the results are controversial. We performed a systematic literature search to identify prospective randomized controlled trials (RCTs) investigating the efficacy of MTAs in the treatment of GEJ carcinoma patients. The endpoint was overall survival (OS) with secondary endpoints progression-free survival (PFS). Statistical analyses were conducted by using Comprehensive Meta Analysis software (Version 2.0). A total of 818 GEJ carcinoma patients from eight RCTs were included for analysis. The pooled results demonstrated that the use of MTAs significantly improved OS (HR 0.67, 95% CI: 0.50-0.92, P= 0.013) and PFS (HR 0.79, 95% CI: 0.65-0.95, P= 0.012) in EGJ carcinoma. Subgroup analyses favored greater benefit for OS (HR 0.48) and PFS (HR 0.61) in chemotherapy-refractory patients compared to chemotherapy-native patients (HR 0.94 and 0.91, respectively). No publication bias was detected by Begg's and Egger's tests for PFS (P= 0.26 and P= 0.05) and OS (P= 0.80, and P= 0.48). Our data indicates that the addition of MTAs to standard therapy in GEJ carcinoma patients significantly improves OS and PFS. Sub-group analysis indicates that improved efficacy is only observed in second-line setting, but not in the first-line setting. Further RCTs with larger samples are needed to confirm these findings.