Abstract
BackgroundRecent meta-analyses have found a survival advantage with gemcitabine based combinations over single agent gemcitabine in patients with advanced pancreatic cancer. There is paucity of evidence in the form of direct head-to-head randomised controlled trials to determine which combinations are to be preferred.MethodUsing the adjusted indirect comparison method proposed by Bucher et al, we have assessed randomised controlled trials of four gemcitabine based combinations namely gemcitabine plus a platinum compound or 5-fluorouracil or irinotecan or capecitabine.ResultsNo particular combination was significantly superior to another, but the indirect evidence suggests some important trends.ConclusionThe strongest trends on indirect comparison are towards favouring gemcitabine plus capecitabine or gemcitabine plus a platinum compound over gemcitabine plus irinotecan, and to a lesser degree, over gemcitabine plus 5-fluorouracil.
Highlights
Recent meta-analyses have found a survival advantage with gemcitabine based combinations over single agent gemcitabine in patients with advanced pancreatic cancer
We have previously reported a systematic review and meta-analysis of 19 studies evaluating gemcitabine based combination chemotherapy compared to gemcitabine alone [1] in patients with locally advanced and metastatic pancreatic cancer
Overall survival was significantly better for gemcitabine based combination chemotherapy (14 trials 4060 patients Hazard ratio (HR) 0.91; 95% Confidence interval (CI) 0.85 to 0.97) compared to single agent gemcitabine
Summary
Recent meta-analyses have found a survival advantage with gemcitabine based combinations over single agent gemcitabine in patients with advanced pancreatic cancer. The subgroup analysis found evidence to suggest a survival advantage for gemcitabine combined with either a platinum agent (HR 0.85; 95% CI 0.74 to 0.96) or capecitabine (HR 0.83; 95% CI 0.72 to 0.96), and insufficient evidence to support combinations of gemcitabine with either 5FU (HR 0.98; 95% CI 0.86 to 1.11) or irinotecan (HR 1.01; 95% CI 0.84 to 1.22). These analyses provide estimates of the survival advantage for each combination compared to single agent gemcitabine but do not provide estimates of the survival advantage for (page number not for citation purposes). Hermann 2005 [13,14] (analyses based on data from abstract published in 2005, plus extra data provided by trialist) Scheithauer 2003 [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
