Summary of findings 5. Irinotecan versus non‐irinotecan‐containing regimens for advanced gastric cancer.
| Irinotecan versus non‐irinotecan‐containing regimens for advanced gastric cancer | ||||||
|
Patient or population: people with advanced gastric cancer
Settings: outpatient clinics participating in international multicentre studies
Intervention: irinotecan Control: non‐irinotecan‐containing regimens | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Non‐irinotecan‐containing regimens | Chemotherapy with Irinotecan | |||||
| Overall survival | Study population | HR 0.87 (0.80 to 0.95) | 2135 (10 studies) | ⊕⊕⊕⊝ moderate1 | Weighted average of median survival durations from included studies | |
| 9.7 months | 11.3 months | |||||
| Overall survival ‐ Substitutive comparisons | Study population |
HR 0.87 (0.75 to 1.00) |
826 (6 studies) | ⊕⊕⊕⊝ moderate1 | Weighted average of median survival durations from included studies | |
| 9.1 months | 9.9 months | |||||
| Overall survival ‐ Additive comparisons | Study population | HR 0.88 (0.76 to 1.03) | 500 (3 studies) | ⊕⊕⊝⊝ low1,2 | Weighted average of median survival durations from included studies | |
| 10.9 months | 11.9 months | |||||
| Overall survival ‐ Other comparisons | Study population | HR 0.87 (0.76 to 1.00) | 809 (2 studies) | ⊕⊝⊝⊝ very low1,3 | Weighted average of median survival durations from included studies | |
| 11.4 months | 12.6 months | |||||
| Tumour response | Study population |
OR 1.72 (1.24 to 2.40) |
1266 (10 studies) | ⊕⊕⊝⊝ low3 | ||
| 288 per 1000 | 410 per 1000 (334 to 493) | |||||
| Moderate | ||||||
| 275 per 1000 | 395 per 1000 (320 to 477) | |||||
| Tumour response ‐ Substitutive comparisons | Study population |
OR 1.53 (0.93 to 2.50) |
756 (6 studies) | ⊕⊕⊝⊝ low3 | ||
| 297 per 1000 | 393 per 1000 (282 to 514) | |||||
| Moderate | ||||||
| 294 per 1000 | 389 per 1000 (279 to 510) | |||||
| Tumour response ‐ Additive comparisons | Study population |
OR 2.18 (1.25 to 3.80) |
345 (3 studies) | ⊕⊕⊝⊝ low1,2 | ||
| 224 per 1000 | 386 per 1000 (265 to 522) | |||||
| Moderate | ||||||
| 219 per 1000 | 379 per 1000 (260 to 516) | |||||
| Tumour response ‐ Other comparisons | Study population | OR 1.87 (0.89 to 3.91) | 165 (2 studies) | ⊕⊝⊝⊝ very low1,2,4 | ||
| 376 per 1000 | 530 per 1000 (350 to 702) | |||||
| Moderate | ||||||
| 367 per 1000 | 520 per 1000 (340 to 694) | |||||
| Progression‐free survival | Study population |
HR 0.76 (0.69 to 0.84) |
1640 (7 studies) | ⊕⊕⊕⊕ high | Weighted average of median survival durations from included studies | |
| 4.4 months | 5.9 months | |||||
| Progression‐free survival ‐ Substitutive comparison | Study population |
HR 0.85 (0.72 to 1.00) |
741 (5 studies) | ⊕⊕⊕⊝ moderate1 | Weighted average of median survival durations from included studies | |
| 4.2 months | 5.3 months | |||||
| Progression‐free survival ‐ Additive comparisons | Study population | HR 0.51 (0.33 to 0.77) | 90 (1) | ⊕⊕⊕⊝ moderate2 | Median survival durations from the only included study | |
| 3.2 months | 6.9 months | |||||
| Progression‐free survival ‐ Other comparisons | Study population |
HR 0.74 (0.66 to 0.84) |
809 (2 studies) | ⊕⊕⊕⊕ high | Weighted average of median survival durations from included studies | |
| 5.4 months | 6.6 months | |||||
| Treatment‐related death | Study population |
OR 0.88 (0.23 to 3.32) |
1979 (9 studies) | ⊕⊕⊝⊝ low2,4 | ||
| 10 per 1000 | 9 per 1000 (2 to 32) | |||||
| Moderate | ||||||
| 2 per 1000 | 2 per 1000 (0 to 7) | |||||
| Treatment discontinuation due to toxicity | Study population |
OR 1.00 (0.46 to 2.20) |
1979 (9 studies) | ⊕⊝⊝⊝ very low2,3 | ||
| 137 per 1000 | 137 per 1000 (68 to 258) | |||||
| Moderate | ||||||
| 215 per 1000 | 215 per 1000 (112 to 376) | |||||
| *For time‐to‐event outcomes, e.g. overall survival, the assumed and corresponding risks were obtained by calculating the weighted average of the median survival durations reported in included studies. For dichotomous outcomes, the assumed and corresponding risks (and their 95% confidence interval) are based on proportions of events in the control and intervention groups respectively. CI: Confidence interval; OR: Odds ratio; HR: Hazard ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Downgraded by one level for risk of bias. 2 Downgraded by one level for imprecision. 3 Downgraded by two levels for severe statistical heterogeneity. 4 Downgraded by one level for statistical heterogeneity.