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Meta-analysis on inoperable pancreatic cancer: a comparison between gemcitabine-based combination therapy and gemcitabine alone Xie DR; Liang HL; Wang Y; Guo SS; Yang QWorld J Gastroenterol 2006[Nov]; 12 (43): 6973-81AIM: To compare gemcitabine-based combination therapy and gemcitabine (GEM) alone in patients with advanced pancreatic cancer (APCa) through meta-analysis. METHODS: MEDLINE and EMBASE searches were supplemented by information from trial registers of randomized controlled trials (RCTs) for GEM-based combination therapy and GEM alone for APCa. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The meta-analysis involved overall survival (OS), objective remission rate (ORR), clinical benefit rate (CBR), time to progress/progress free survival (TTP/PFS) and toxicity. RESULTS: The meta-analysis included 22 RCTs. There was significant improvement in the GEM combination group with regard to the 6-mo survival rate (RD = 0.04, 95% CI 0.01-0.06, P = 0.008), 1-year survival rate (RD = 0.03, 95% CI 0.01-0.05, P = 0.01), ORR (RD = 0.04, 95% CI 0.01-0.07, P = 0.02), CBR (RD = 0.10, 95% CI 0.02-0.17, P = 0.01) and 6-mo TTP/PFS (RD = 0.07, 95% CI 0.04-0.10, P < 0.00001). However, the Grade 3-4 toxicity set by WHO was higher for the GEM combination group for neutropenia (RD = 0.05, 95% CI 0.01-0.10, P = 0.02), thrombocytopenia (RD = 0.05, 95% CI 0.02-0.08, P = 0.002) and vomiting/nausea (RD = 0.03, 95% CI 0.00-0.05, P = 0.02). CONCLUSION: GEM-based combination therapy may improve the overall survival and palliation in optimal patients with APCa as compared with GEM alone.|Antimetabolites, Antineoplastic/adverse effects/*therapeutic use[MESH]|Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use[MESH]|Deoxycytidine/adverse effects/*analogs & derivatives/therapeutic use[MESH]|Disease Progression[MESH]|Dose-Response Relationship, Drug[MESH]|Gemcitabine[MESH]|Humans[MESH]|Pancreatic Neoplasms/*drug therapy[MESH]|Prospective Studies[MESH]|Randomized Controlled Trials as Topic[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH] |
