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Friday, September 21, 2012 12:56:33 AM
Role of gemcitabine-based combination therapy in the management of advanced pancreatic cancer: A meta-analysis of randomised trials
European Journal of Cancer online Sept 16, 2012
http://www.sciencedirect.com/science/article/pii/S0959804912006818
Background
Pancreatic cancer is the fourth leading cause of cancer-related death worldwide. Gemcitabine is the mainstay treatment for advanced disease. However, almost all up-to-date trials, that evaluated the benefit of gemcitabine-combination schedules, failed to demonstrate an improvement in overall survival (OS). In this study, we performed a systematic review and a meta-analysis of randomised clinical trials (RCTs) to investigate the efficacy and safety of gemcitabine-based combination regimens as compared to gemcitabine alone in the management of pancreatic cancer.
Findings: Thirty-four trials for a total of 10,660 patients were selected and included in the final
analysis. The analysis showed that combination chemotherapy confers benefit in terms of OS
(HR: 0.93; 95% confidence interval (CI): 0.89–0.97; p = 0.001).
Here is Table 1 from this paper showing 34 randomized trials. Every trial used GEM as the control arm,
and the combination treatment arms all used GEM + something.
![](http://investorshub.advfn.com/uimage/uploads/2012/9/21/turjbTable1_meta_analysis.jpg)
Here I took the 32 with survival numbers and put them in a spreadsheet to calculate the mean
and standard deviation across the 32 trials. This gives us an idea of the variation across trials with
different patient groups and treatments added to GEM. It doesn't look too good. The treatment mean OS
is only 11% longer than the control mean. There are a few outliers. The two best are with the drug S-1.
If Bavi +GEM could double survival it would be a major improvement.
![](http://investorshub.advfn.com/uimage/uploads/2012/9/21/dgxtcMeta_analysis_stats.jpg)
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