Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 21, 2012; 18(35): 4944-4958
Published online Sep 21, 2012. doi: 10.3748/wjg.v18.i35.4944
Does gemcitabine-based combination therapy improve the prognosis of unresectable pancreatic cancer?
Chen Sun, Daniel Ansari, Roland Andersson, De-Quan Wu
Chen Sun, De-Quan Wu, Department of Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Chen Sun, Daniel Ansari, Roland Andersson, Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-22185 Lund, Sweden
Author contributions: Sun C and Ansari D performed the majority of the study and wrote the manuscript; Andersson R and Wu DQ conceived the study and finalized the revision; all authors read and approved the final manuscript.
Correspondence to: De-Quan Wu, MD, PhD, Department of Surgery, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin 150086, Heilongjiang Province, China. dqwu56@163.com
Telephone: +86-451-86605535 Fax: +86-451-82524051
Received: December 17, 2011
Revised: February 1, 2012
Accepted: April 12, 2012
Published online: September 21, 2012
Abstract

AIM: To assess whether gemcitabine-based combination therapy improves the prognosis of unresectable pancreatic cancer compared with gemcitabine treatment alone.

METHODS: A quantitative up-to-date meta-analysis was undertaken to investigate the efficacy of gemcitabine-based combination treatment compared with gemcitabine monotherapy in locally advanced or metastatic pancreatic cancer. Inclusion was limited to high-quality randomized clinical trials.

RESULTS: Twenty-six studies were included in the present analysis, with a total of 8808 patients recruited. The studies were divided into four subgroups based on the different kinds of cytotoxic agents, including platinum, fluoropyrimidine, camptothecin and targeted agents. Patients treated with gemcitabine monotherapy had significantly lower objective response rate [risk ratio (RR), 0.72; 95% confidence interval (CI): 0.63-0.83; P < 0.001], and lower 1-year overall survival (RR, 0.90; 95%CI: 0.82-0.99; P = 0.04). Gemcitabine monotherapy caused fewer complications, including fewer grade 3-4 toxicities: including vomiting (RR, 0.75; 95%CI: 0.62-0.89; P = 0.001), diarrhea (RR, 0.66; 95%CI: 0.49-0.89; P = 0.006), neutropenia (RR, 0.88; 95%CI: 0.72-1.06; P = 0.18), anemia (RR, 0.96; 95%CI: 0.82-1.12; P = 0.60), and thrombocytopenia (RR, 0.76; 95%CI: 0.60-0.97; P = 0.03) compared with gemcitabine combination therapies.

CONCLUSION: Gemcitabine combination therapy provides a modest improvement of survival, but is associated with more toxicity compared with gemcitabine monotherapy.

Keywords: Pancreatic cancer; Gemcitabine; Combination therapy; Outcome; Meta-analysis