论文已发表
注册即可获取德孚的最新动态
IF 收录期刊
Authors Zhang S, Xie W, Zou Y, Xie S, Zhang J, Yuan W, Ma J, Zhao J, Zheng C, Chen Y, Wang C
Received 18 January 2018
Accepted for publication 15 May 2018
Published 20 November 2018 Volume 2018:10 Pages 5965—5978
DOI https://doi.org/10.2147/CMAR.S162980
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Dr Leylah Drusbosky
Background: Systemic
chemotherapy is the standard treatment for locally advanced and metastatic
pancreatic cancer, but there is no consensus on the optimum regimen. We aimed
to compare and rank the locally advanced and metastatic pancreatic
adenocarcinoma chemotherapy regimens evaluated in randomized controlled trials
(RCTs) in the past 15 years.
Materials and methods: PubMed,
Embase, Cochrane Collaboration database, and ClinicalTrials.gov were searched
for RCTs comparing chemotherapy regimens as first-line treatment for locally
advanced and metastatic pancreatic adenocarcinomas. By using Bayesian network
meta-analysis, we compared and ranked all included chemotherapy regimens in
terms of overall survival, progression-free survival, response rate, and
hematological toxicity.
Results: The analysis
included 68 RCTs, with 14,908 patients and 63 treatment strategies. For overall
survival, NSC-631570 (hazard ratio [HR] vs gemcitabine monotherapy 0.44, 95%
credible interval: 0.24–0.76) and gemcitabine+NSC-631570 (HR 0.45, 0.24–0.86)
were the two top-ranked chemotherapy regimens. For progression-free survival,
PEFG (cisplatin + epirubicin + fluorouracil + gemcitabine) ranked first
(HR 0.51, 0.34–0.77). PG (gemcitabine + pemetrexed) (odds ratio [OR] 4.68,
2.24–9.64) and FLEC (fluorouracil + leucovorin + epirubicin + carboplatin) (OR
4.52, 1.14–24.00) were ranked the most hematologically toxic, with gastrazole
having the least toxicity (OR 0.03, 0.00–0.46).
Conclusion: The
chemotherapy regimens NSC-631570 and gemcitabine+NSC-631570 were ranked the
most efficacious for locally advanced and metastatic pancreatic adenocarcinomas
in terms of overall survival, which warrants further confirmation in
large-scale RCTs.
Keywords: locally
advanced and metastatic pancreatic adenocarcinoma, chemotherapy regimen,
overall survival, rank