Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2006; 12(43): 6973-6981
Published online Nov 21, 2006. doi: 10.3748/wjg.v12.i43.6973
Meta-analysis on inoperable pancreatic cancer: A comparison between gemcitabine-based combination therapy and gemcitabine alone
De-Rong Xie, Han-Lin Liang, Yu Wang, Shuan-Shuan Guo, Qiong Yang
De-Rong Xie, Shuan-Shuan Guo, Qiong Yang, Department of Oncology, The Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China
Han-Lin Liang, Department of Chemotherapy, Zhongshan People’s Hospital, Sun Yat-Sen University, Zhoushan 528403, Guangdong Province, China
Yu Wang, Department of Oncology, Jiangmen Central Hospital, Jiangmen 529000, Guangdong Province, China
Author contributions: All authors contributed equally to the work.
Correspondence to: De-Rong Xie, Department of Oncology, Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China. xiederong@21cn.con
Telephone: +86-20-81332616 Fax: +86-20-81332505
Received: July 18, 2006
Revised: October 2, 2006
Accepted: October 11, 2006
Published online: November 21, 2006
Abstract

AIM: 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.

Keywords: Chemotherapy, Pancreatic cancer, Meta-analysis, Gemcitabine