Short-term Therapeutic Effect Of Recombinant Human Endostatin Combined With Chemotherapy For Advanced Gastric Cancer:a Meta-analysis

ObjectiveTo evaluate the efficacy and safety of Recombinant Human Endostatin(Endostar) combined with chemotherapy for patients with advanced gastric cancer.MethodsA computer-based online search was performed by using PubMed, Medline, Cochrane library, Elsevier, Chinese BioMedical Literature Database, National Knowledge Infrastructure and WanFang Database. In accordance with the inclusion and exclusion criteria, the randomized controlled trials on the short-term therapeutic effect of Recombinant Human Endostatin combined with chemotherapy for advanced gastric cancer were selected. Quality of the studies was assessed using Jadad scale. After data extraction, a meta-analysis was performed by using RevMan5.2 software. Relative risk(RR) and its 95% confidence interval (CI) were calculated. Q statistics test and heterogeneous index I2 were used to detect the heterogeneity. The funnel plot and the Egger test by using Statal2.0 software were performed to detect the publication bias.Results10 eligible randomized controlled trials were included in this meta-analysis involving 623 patients (the group of chemotherapy alone involving 308 patients and the group of Endostar combined with chemotherapy involving 315 patients). The results showed that there were significant improvement in CR(complete response) rate(9.21% vs 3.57%,RR=2.24,95%CI:1.21-4.15,P=0.01),PR(partial response) rate(46.35% vs 31.49%,RR=1.47,95%CI:1.21-1.80,P=0.0001),ORR(overall response rate) (54.60% vs 39.29%, RR=1.39,95%CI:1.17-1.65, P=0.0002) and CBR(clinical benefit rate) (81.27% vs 69.48%, RR=1.17,95%CI:1.06-1.28, P=0.0010) in Endostar combined with chemotherapy group, as compared with chemotherapy along group. And there was no significant difference in SD(stable disease) rate(26.67% vs 30.19%, P=0.31) between the two groups. But the PD(disease progression) rate(19.05% vs 29.87%, P=0.003) was significantly lower in Endostar combined with chemotherapy group, as compared with chemotherapy along group. Meanwhile, there were no statistically significant differences in myelosuppression(61.96% vs 65.10%,RR=0.95,95%CI:0.85-1.07 P=0.42) and gastrointestinal reaction (58.03% vs 57.38%,RR=1.01,95%CI:0.88-1.15, P=0.93).However, there was higher rate of cardiotoxicity(12.36% vs 4.19%, RR=2.82, 95%CI:1.32-6.00, P=0.007).ConclusionThis meta-analysis indicates that in comparison with chemotherapy alone,Endostar combined with chemotherapy had better therapeutic effects on advanced gastric cancer and the common adverse events do not increase. Therefore Endostar can be used as a routine drug for advanced gastric cancer. Meanwhile, it also increases the rate of cardiotoxicity which should be pay attention to.