Cancer Chemotherapy and Pharmacology

, Volume 81, Issue 6, pp 981–989 | Cite as

Survival impact of post-progression chemotherapy in advanced gastric cancer: systematic review and meta-analysis

  • Sakura Iizumi
  • Atsuo Takashima
  • Kentaro Sakamaki
  • Satoshi Morita
  • Narikazu Boku
Original Article



We conducted a systematic review and meta-analysis on survival impact of post-progression chemotherapy (post-Cx) after first-line chemotherapy (1st-Cx) and after second-line chemotherapy (2nd-Cx), and survival benefit of third-line chemotherapy (3rd-Cx) for advanced gastric cancer (AGC).


Phase III trials of systemic chemotherapy for AGC published in English between 2005 and 2015 or presented at annual meetings of ASCO or ESMO between 2013 and 2015 were searched. Numbers of patients, types of chemotherapy, patient baseline, proportion of patients receiving post-Cx (post-Cx%), median progression-free survival (mPFS), and median overall survival (mOS) of each treatment arm were surveyed; trials not reporting these parameters were excluded. Median post-progression survival (mPPS) was calculated as the difference between mOS and mPFS. Weighted Spearman’s correlation coefficients between post-Cx% and survival outcomes (mOS and mPPS) were calculated. The effect of post-Cx% on survival outcomes adjusted for the types of chemotherapy and patient characteristics was evaluated by meta-regression.


Overall, 25 phase III trials of AGC were selected: 15 trials with 31 arms for 1st-Cx, and 10 trials with 16 arms for 2nd-Cx. Weighted Spearman’s correlation coefficients for post-Cx% and mOS/mPPS were 0.520/0.739 for 1st-Cx, and 0.767/0.823 for 2nd-Cx. Meta-regression analyses adjusting for types of chemotherapy, age, and PS showed that a 10% increase in post-Cx% was associated with prolongation of mOS by 1.033 months for 1st-Cx and 0.344 months for 2nd-Cx.


Post-Cx% both after 1st-Cx and 2nd-Cx were correlated with mOS/mPPS, suggesting a survival benefit of 3rd-Cx in addition to that of 2nd-Cx for AGC.


Gastric cancer Post-progression survival First-line chemotherapy Second-line chemotherapy Third-line chemotherapy 




Compliance with ethical standards

Conflict of interest

The authors have declared no conflicts of interest.

Ethical approval

This study itself does not involve any interventions on human participants or animals performed by any of the authors. Ethical approval was not required for this study because only publicly available data were used.

Informed consent

Informed consent was not required for this study.

Supplementary material

280_2018_3569_MOESM1_ESM.docx (36 kb)
Supplementary material 1 (DOCX 35 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastrointestinal Medical OncologyNational Cancer Center HospitalTokyoJapan
  2. 2.Department of MedicineKeio University Graduate School of MedicineTokyoJapan
  3. 3.Department of Biostatistics and BioinformaticsUniversity of Tokyo Graduate School of MedicineTokyoJapan
  4. 4.Department of Biomedical Statistics and BioinformaticsKyoto University Graduate School of MedicineKyotoJapan

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