Gemcitabine Compared With Gemcitabine and S-1 Combination Therapy in Advanced Pancreatic Cancer

Li, Doudou; Chen, Changhao; Zhou, Yu; Chen, Rufu; Fan, Xinxiang; Bi, Zhuofei; Li, Zhihua; Liu, Yimin

doi:10.1097/md.0000000000001345

Cited by 11 publications

(5 citation statements)

References 40 publications

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“…However, subgroup analysis showed that GEM plus CAP and GEM plus S-1 could effectively improve OS, PFS, and ORR, but GEM plus CIS did not achieve the same effect. Li et al's meta-analysis compared the effects of GEM plus fluorouracil-based drugs (CAP and S-1) with GEM alone in advanced pancreatic cancer, and they concluded that compared with GEM alone, GEM combined with fluorouracil significantly improved OS and increased 1-year survival and ORR in patients with advanced pancreatic cancer (43). Zhou et al's meta-analysis compared the effects of GEM plus CIS and GEM alone in advanced pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of gemcitabine-based combination therapy vs. gemcitabine alone for the treatment of advanced pancreatic cancer: a systematic review and meta-analysis

Zhang¹,

He²,

Wang³

et al. 2022

J Gastrointest Oncol

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Background: Gemcitabine (GEM) is used as a standard first-line drug to effectively alleviate symptoms and prolong survival time for advanced pancreatic cancer. Most randomized controlled trials (RCTs) show that GEM-based combination therapy is better than GEM alone, while some RCTs have the opposite conclusion. This study aimed to investigate whether GEM-based combination therapy would be superior to GEM alone by a systematic review and meta-analysis.Methods: According to the PICOS principles, RCTs (S) focused on comparing GEM-based combination therapy (I) vs. GEM alone (C) for advanced pancreatic cancer (P) were collected from eight electronic databases, outcome variables mainly include survival status and adverse events (AEs) (O). Review Manager 5.4 was used to evaluate the pooled effects of the results among selected articles. Pooled estimate of hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were used as measures of effect sizes. Quality assessment for individual study was performed using the Cochrane tool for risk of bias.Results: A total of 17 studies including 5,197 patients were selected in this analysis. The pooled results revealed that GEM-based combination therapy significantly improved the overall survival (OS; HR =0.84; 95% CI: 0.79 to 0.90; P<0.001), progression-free survival (PFS; HR =0.78; 95% CI: 0.72 to 0.84; P<0.001), overall response rate (ORR; OR =1.92; 95% CI: 1.61 to 2.30; P<0.001), 1-year survival rate (OR =1.44; 95% CI: 1.02 to 2.03; P=0.04), respectively. Subgroup analysis showed that the efficacy of GEM plus capecitabine (CAP) and GEM plus S-1 was better than that of GEM alone, while GEM plus cisplatin (CIS) did not achieve an improved effect. GEM-based combination therapy can significantly increase the incidence of AEs, such as leukopenia (P<0.001), neutropenia (P<0.001), anemia (P<0.05), nausea (P<0.001), diarrhea (P<0.05), and stomatitis (P<0.001). No publication bias existed in our meta-analysis (P>0.10).Discussion: Our study supported that GEM-based combination therapy was more beneficial to improve patient's survival than GEM alone, while there was no additional benefits in GEM plus CIS. We also found that GEM-based combination therapy increased the incidence of AEs. Clinicians need to choose the appropriate combination therapy according to the specific situation.

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Section: Discussionmentioning

confidence: 99%

The efficacy and safety of gemcitabine-based combination therapy vs. gemcitabine alone for the treatment of advanced pancreatic cancer: a systematic review and meta-analysis

Zhang¹,

He²,

Wang³

et al. 2022

J Gastrointest Oncol

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“…Pancreatic cancer is a lethal malignancy with a modest response to systemic chemotherapy [21]. Although GS treatment is associated with a higher response rate [14], and better PFS [14] and OS [22] than gemcitabine in APC [19,20], a substantial proportion of our patients still had progressive disease and, therefore, were exposed to unnecessary toxicity. Using patients’ clinical variables in conjunction with their laboratory test values, we developed a prognostic model for the prediction of survival outcomes in patients with APC who underwent palliative chemotherapy with GS.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Advanced Pancreatic Cancer Treated with Gemcitabine Plus S-1: Retrospective Analysis and Development of a Prognostic Model

Chang

Huang

Chen

et al. 2019

Cancers

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Gemcitabine plus S-1 (GS) is commonly used to treat advanced pancreatic cancer (APC) in Asia. Few clinical experiments have demonstrated the clinical efficacy of GS in routine clinical practice. We aimed to identify the prognostic factors and develop a prognostic model for survival prediction in patients with APC, treated with GS. Records of 111 patients with newly diagnosed APC who received first-line palliative GS chemotherapy during 2010–2016 in Taiwan were analyzed retrospectively. Univariate and multivariate analyses were performed for the identification of prognostic factors. A prognostic model using prognosticators from the multivariate analysis was developed for survival prediction. The median overall survival (OS) for the cohort was 9.3 months (95% confidence interval [CI], 8.0–10.6). The prognostic model was constructed based on four independent prognosticators: performance status, tumor stage, pre-treatment albumin level, and neutrophil-to-lymphocyte ratio. Patients were categorized by tertiles into good, intermediate, and poor prognostic groups. The median OS values for each of these groups were 21.1 (95% CI, 8.2–33.9), 9.2 (95% CI, 8.3–10.1), and 5.8 months (95% CI, 4.4–7.1; log-rank p < 0.001), respectively. The bootstrapped corrected C-index of this model was 0.80 (95% CI, 0.71–0.89). The developed model was robust and could accurately predict survival in this population, and can assist clinicians and patients in survival discrimination and the determination of appropriate medical care goals. Additional research is needed to externally validate the model’s performance.

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“…Several meta-analysis studies indicate that GEM/S-1 combination therapy, as a first-line treatment, may be more effective at increasing survival rates in patients with unresectable pancreatic cancer (5,24). Qing-Hua et al showed that GEM/S-1 combination therapy followed by oral S-1 with intensity-modulated radiotherapy (IMRT) protocol achieved a 2-year survival rate of 34.4%, which was similar to the results we have outlined in this study (2-year survival rate of 33.3%) (11).…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine and S-1 Induction Chemotherapy Followed by Chemoradiotherapy for Locally Advanced Pancreatic Cancers

Maemura

Mataki

Kurahara

et al. 2017

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Gemcitabine Compared With Gemcitabine and S-1 Combination Therapy in Advanced Pancreatic Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 11 publications

References 40 publications

The efficacy and safety of gemcitabine-based combination therapy vs. gemcitabine alone for the treatment of advanced pancreatic cancer: a systematic review and meta-analysis

The efficacy and safety of gemcitabine-based combination therapy vs. gemcitabine alone for the treatment of advanced pancreatic cancer: a systematic review and meta-analysis

Prognostic Factors for Advanced Pancreatic Cancer Treated with Gemcitabine Plus S-1: Retrospective Analysis and Development of a Prognostic Model

Gemcitabine and S-1 Induction Chemotherapy Followed by Chemoradiotherapy for Locally Advanced Pancreatic Cancers

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