Quality of life during palliative systemic therapy for oesophagogastric cancer: systematic review and meta-analysis
A partir d'une revue systématique de la littérature (43 essais randomisés, 13 727 patients), cette étude analyse les effets des traitements systémiques à visée palliative sur la qualité de vie chez des patients atteints d'un cancer œsogastrique
Background : Palliative systemic therapy can prolong life and reduce tumour related symptoms for patients with advanced oesophagogastric cancer. However, side effects of treatment could negatively impact health-related quality of life (HRQoL). Our aim was to review the literature and conduct a meta-analysis to examine the effect of palliative systemic therapy on HRQoL. Methods : EMBASE, Medline and CENTRAL were searched for phase II/III randomized controlled trials (RCTs) till April 2018 investigating palliative systemic therapy and HRQoL. Meta-analysis was performed on baseline and follow-up summary values of Global Health Status (GHS) and other EORTC scales. A clinically relevant change and difference of 10 points (scale 0-100) was set to assess the course of HRQoL over time within treatment arms as well as between arms. Results : We included 43 RCTs (N = 13,727 patients). In the first-line and beyond first-line treatment setting, pooled baseline GHS mean estimates were 54.6 (51.9-57.3) and 57.9 (55.7-60.1), respectively. Thirty-nine (81.3%) treatment arms showed a stable GHS over the course of time. Anthracycline-based triplets, fluoropyrimidine-based doublets without cisplatin, and the addition of trastuzumab to chemotherapy were found to have favourable HRQoL outcomes. HRQoL benefit was observed for taxane monotherapy and several targeted agents over best supportive care beyond first-line. Conclusions : Patients reported impaired GHS at baseline and generally remained stable over time. Anthracycline-based triplets and fluoropyrimidine-based doublets without cisplatin may be preferable first-line treatment options regarding HRQoL for HER2-negative disease. Taxanes and targeted agents could provide HRQoL benefit beyond first-line compared to best supportive care.