Cisplatin/gemcitabine or oxaliplatin/gemcitabine in the treatment of advanced biliary tract cancer: a systematic review

Abstract

Cisplatin/gemcitabine association has been a standard of care for first-line regimen in advanced biliary tract cancer nevertheless oxaliplatin/gemcitabine regimen is frequently preferred. Because comparative effectiveness in clinical outcomes of cisplatin- versus oxaliplatin-containing chemotherapy is not available, a systematic review of studies assessing cisplatin/gemcitabine or oxaliplatin/gemcitabine chemotherapies in advanced biliary tract cancer was performed. Published studies evaluating cisplatin/gemcitabine or oxaliplatin/gemcitabine in advanced biliary tract cancer were included. Each study was weighted according to the number of patients included. The primary objective was to assess weighted median of medians overall survival (mOS) reported for both regimens. Secondary goals were to assess weighted median of medians progression-free survival (mPFS) and toxic effects were pooled and compared within each arm. Thirty-three studies involving 1470 patients were analyzed. In total, 771 and 699 patients were treated by cisplatin/gemcitabine and oxaliplatin/gemcitabine, respectively. Weighted median of mOS was 9.7 months in cisplatin group and 9.5 months in oxaliplatin group. Cisplatin-based chemotherapy was significantly associated with more grade 3 and 4 asthenia, diarrhea, liver toxicity, and hematological toxicity. Sensitivity analysis including only the studies with the standard regimen of cisplatin (25–35 mg/m2 administered on days 1 and 8) showed that the weighted median of mOS increased from 9.7 to 11.7 months but Gem/CDDP regimen remained more toxic than Gemox regimen. These results suggest that the Gem/CDDP regimen with cisplatin (25–35 mg/m2) administered on days 1 and 8 is associated with survival advantage than Gemox regimen but with addition of toxicity.

Efficacy of a sequential treatment strategy with GEMOX-based followed by FOLFIRI-based chemotherapy in advanced biliary tract cancers

“…Neither response rate nor disease control rate are strongly correlated with OS in BTC meta-analysis experience [5]. A recent systematic review comparing the efficacy and toxicity of GEM-cisplatin and GEMOX across 33 studies highlighted that the small advantage of GEM-cisplatin in term of survival was associated with increased toxicities, which may explain why GEMOX is often preferred to GEM-cisplatin in the advanced patient population [25].…”

Chemotherapy for advanced biliary tract carcinoma

“…Recent systematic reviews have reaffirmed the efficacy of gemcitabine and cisplatin. [11,12] Nevertheless, combination therapy with other drugs, such as fluoropyrimidines and EGFR inhibitors, was not administered. Moreover, several recently published RCTs were not included.…”

Effect of oxaliplatin combined with polyenephosphatidylcholine on the proliferation of human gastric cancer SGC-7901 cells

“…Oxaliplatin (L-OHP) is a third-generation platinum compound that has been developed as an alternative pharmacological compound to cisplatin (4). Its usage decreases the tumor resistance, inadequate oral bioavailability and poisonous side effects associated with the use of cisplatin (5,6).…”

“…LOHP is currently used in combination with other chemotherapy drugs, including 5-fluorouracil, to treat advanced gastric cancer (7,8). The response rate of patients to L-OHP is high (53–59%), and L-OHP exhibits low toxicity (4–6,9–11). However, although L-OHP is an effective anti-tumor treatment, it may cause severe adverse reactions in patients, as it enhances inflammatory activity, thus increasing the risk of hepatic injury (6,12).…”