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

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.