Polychemotherapy or gemcitabine in advanced pancreatic cancer: A meta-analysis

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• 作者：Fausto Petrelli ; ^{faupe@libero.it" class="auth_mail} ; Andrea Coinu ; Karen Borgonovo ; Mary Cabiddu ; Mara Ghilardi ; Sandro Barni
• 关键词：First line ; Gemcitabine ; Meta-analysis ; Overall survival ; Pancreatic cancer ; Polychemotherapy
• 刊名：Digestive and Liver Disease
• 出版年：May, 2014
• 年：2014
• 卷：46
• 期：5
• 页码：452-459
• 全文大小：2371 K

文摘

Background

Gemcitabine monotherapy is the cornerstone of treatment for advanced pancreatic cancer. To date, no clear survival benefit has been found when combination chemotherapy has been compared with gemcitabine alone, except in a few studies. This meta-analysis compared the efficacy of polychemotherapy with gemcitabine alone in advanced pancreatic cancer.

Methods

Randomised trials comparing combination chemotherapy with gemcitabine alone were identified through electronic searches of PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. Overall survival, reported as the hazard ratio at the 95% confidence interval, was the primary outcome measure.

Results

29 trials (19 phase III and 10 small randomised trials) that included 8421 patients were identified. Overall, polychemotherapy significantly improved overall survival (hazard ratio = 0.87; 95% CI, 0.81-0.93; P < 0.0001), progression-free survival (hazard ratio = 0.77; 95% CI, 0.70-0.84; P < 0.00001), and response rate (risk ratio = 1.71; 95% CI, 1.42-2.07; P < 0.00001) compared with gemcitabine alone.

Conclusions

Compared with gemcitabine monotherapy, combinations of two or more drugs (particularly those with novel agents or associated with >20% response rates and triplets) improved outcomes and response rate in advanced pancreatic cancer, and they could be considered a new standard of care in advanced settings.