PMID- 36092340
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230314
IS  - 2078-6891 (Print)
IS  - 2219-679X (Electronic)
IS  - 2078-6891 (Linking)
VI  - 13
IP  - 4
DP  - 2022 Aug
TI  - The efficacy and safety of gemcitabine-based combination therapy vs. gemcitabine 
      alone for the treatment of advanced pancreatic cancer: a systematic review and 
      meta-analysis.
PG  - 1967-1980
LID - 10.21037/jgo-22-624 [doi]
AB  - BACKGROUND: Gemcitabine (GEM) is used as a standard first-line drug to 
      effectively alleviate symptoms and prolong survival time for advanced pancreatic 
      cancer. Most randomized controlled trials (RCTs) show that GEM-based combination 
      therapy is better than GEM alone, while some RCTs have the opposite conclusion. 
      This study aimed to investigate whether GEM-based combination therapy would be 
      superior to GEM alone by a systematic review and meta-analysis. METHODS: 
      According to the PICOS principles, RCTs (S) focused on comparing GEM-based 
      combination therapy (I) vs. GEM alone (C) for advanced pancreatic cancer (P) were 
      collected from eight electronic databases, outcome variables mainly include 
      survival status and adverse events (AEs) (O). Review Manager 5.4 was used to 
      evaluate the pooled effects of the results among selected articles. Pooled 
      estimate of hazard ratio (HR) and odds ratio (OR) with 95% confidence interval 
      (CI) were used as measures of effect sizes. Quality assessment for individual 
      study was performed using the Cochrane tool for risk of bias. RESULTS: A total of 
      17 studies including 5,197 patients were selected in this analysis. The pooled 
      results revealed that GEM-based combination therapy significantly improved the 
      overall survival (OS; HR =0.84; 95% CI: 0.79 to 0.90; P<0.00001), 
      progression-free survival (PFS; HR =0.78; 95% CI: 0.72 to 0.84; P<0.00001), 
      overall response rate (ORR; OR =1.92; 95% CI: 1.61 to 2.30; P<0.00001), 1-year 
      survival rate (OR =1.44; 95% CI: 1.02 to 2.03; P=0.04), respectively. Subgroup 
      analysis showed that the efficacy of GEM plus capecitabine (CAP) and GEM plus S-1 
      was better than that of GEM alone, while GEM plus cisplatin (CIS) did not achieve 
      an improved effect. GEM-based combination therapy can significantly increase the 
      incidence of AEs, such as leukopenia (P<0.001), neutropenia (P<0.001), anemia 
      (P<0.05), nausea (P<0.001), diarrhea (P<0.05), and stomatitis (P<0.001). No 
      publication bias existed in our meta-analysis (P>0.10). DISCUSSION: Our study 
      supported that GEM-based combination therapy was more beneficial to improve 
      patient's survival than GEM alone, while there was no additional benefits in GEM 
      plus CIS. We also found that GEM-based combination therapy increased the 
      incidence of AEs. Clinicians need to choose the appropriate combination therapy 
      according to the specific situation.
CI  - 2022 Journal of Gastrointestinal Oncology. All rights reserved.
FAU - Zhang, Zhaohuan
AU  - Zhang Z
AD  - Department of General Surgery, The First Affiliated Hospital of Jiamusi 
      University, Jiamusi, China.
FAU - He, Shuling
AU  - He S
AD  - Department of General Surgery, The First Affiliated Hospital of Jiamusi 
      University, Jiamusi, China.
FAU - Wang, Ping
AU  - Wang P
AD  - Criminal Technical Detachment, Jiamusi Public Security Bureau, Jiamusi, China.
FAU - Zhou, Yibing
AU  - Zhou Y
AD  - Department of General Surgery, Jiamusi Central Hospital, Jiamusi, China.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Gastrointest Oncol
JT  - Journal of gastrointestinal oncology
JID - 101557751
CIN - J Gastrointest Oncol. 2023 Feb 28;14(1):478-479. PMID: 36915424
PMC - PMC9459213
OTO - NOTNLM
OT  - Gemcitabine (GEM)
OT  - S-1
OT  - capecitabine (CAP)
OT  - cisplatin (CIS)
OT  - pancreatic cancer
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jgo.amegroups.com/article/view/10.21037/jgo-22-624/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2022/09/13 06:00
MHDA- 2022/09/13 06:01
PMCR- 2022/08/01
CRDT- 2022/09/12 04:14
PHST- 2022/06/10 00:00 [received]
PHST- 2022/08/05 00:00 [accepted]
PHST- 2022/09/12 04:14 [entrez]
PHST- 2022/09/13 06:00 [pubmed]
PHST- 2022/09/13 06:01 [medline]
PHST- 2022/08/01 00:00 [pmc-release]
AID - jgo-13-04-1967 [pii]
AID - 10.21037/jgo-22-624 [doi]
PST - ppublish
SO  - J Gastrointest Oncol. 2022 Aug;13(4):1967-1980. doi: 10.21037/jgo-22-624.