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Review
. 2021 Jun 16;21(1):712.
doi: 10.1186/s12885-021-08330-5.

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

M Santero  1 , J Pérez-Bracchiglione  1   2 , R Acosta-Dighero  3 , A G Meade  1 , A Antequera  1 , A Auladell-Rispau  1 , M J Quintana  1   4 , C Requeijo  1 , G Rodríguez-Grijalva  1 , K Salas-Gama  1 , R Dorantes-Romandia  1 , J Salazar  1 , I Solà  1   4 , G Urrútia  1   4 , X Bonfill Cosp  5   6
Affiliations
Review

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

M Santero et al. BMC Cancer. .

Abstract

Background: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context.

Methods: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach.

Results: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence.

Conclusions: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed.

Trial registration: Open Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6 .

Keywords: Antineoplastic agents; Biological therapy; Esophageal Cancer; Gastric Cancer; Immunotherapy; Molecular targeted therapy; Review literature as topic; Systematic reviews.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

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Fig. 1
Eligibility criteria
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PRISMA flow diagram
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Overlap matrix
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Risk of bias Assessment
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Fig. 5
Overall survival and progression-free survival for systemic oncological treatment versus supportive treatment in advanced esophageal or gastric cancers
See this image and copyright information in PMC

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