Comparison of gemcitabine combined with targeted agent therapy versus gemcitabine monotherapy in the management of advanced pancreatic cancer.

Abstract

PURPOSE:

Targeted therapy has brought great clinical benefits for patients with multiple solid tumors, but its effects in patients with locally advanced/metastatic pancreatic cancer (LA/MPC) are disputed. This systematic evaluation compared the efficacy and safety profiles of gemcitabine combined with targeted agents (GEM + TA) versus gemcitabine administered as monotherapy or combined with placebo (GEM ± PLC) in LA/MPC patients.

METHODS:

PubMed and EMBASE were searched for relevant randomized controlled trials published on or before April 30, 2013. The primary end points were overall survival (OS) and progression-free survival (PFS); the secondary end points were 1-year survival rate, objective response rate (ORR), and toxicity rates (TRs), defined as the prevalence of grade 3/4 adverse events. The systematic evaluation was performed by using Review Manager version 5.1.7.

FINDINGS:

A total of 10 randomized controlled trials involving 3899 patients (2195 males; mean age, 63.6 years) were included in the systematic evaluation. The results reported that there was no significant difference in OS (hazard ratio [HR] = 0.97 [P = 0.85]), PFS (HR = 0.95 [P = 0.14]), or ORR (odds ratio [OR] = 0.95 [P = 0.69]) between GEM + TA and GEM ± PLC. However, a marginal difference in 1-year survival rate (OR = 0.80 [P = 0.05]) between the 2 groups was observed. The grade 3/4 TRs of anemia, diarrhea, nausea, neutropenia, thrombocytopenia, and vomiting were not significantly different between the 2 groups. However, the prevalence of grade 3/4 rash was significantly greater in the GEM + TA group (OR = 8.31 [P < 0.01]).

IMPLICATIONS:

Based on the results from this analysis, the addition of targeted agents to a regimen of gemcitabine treatment does not bring survival benefits except 1-year survival rate to patients with LA/MPC.

• Authors: Qin Li, Zhenyan Yuan, Han Yan, Zhaoyang Wen, Ruixue Zhang, Bangwei Cao
• Journal: Clinical therapeutics (Clin Ther) Vol. 36 Issue 7 Pg. 1054-63 (Jul 01 2014) ISSN: 1879-114X [Electronic] United States
• PMID: 24986485 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Deoxycytidine
• Gemcitabine

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols
• Databases, Bibliographic
• Deoxycytidine (analogs & derivatives, therapeutic use)
• Humans
• Male
• Meta-Analysis as Topic
• Middle Aged
• Molecular Targeted Therapy
• Pancreatic Neoplasms (drug therapy)
• Randomized Controlled Trials as Topic
• Survival Analysis
• Gemcitabine