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.
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.
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.