title: Efficacy and safety profile of combining agents against epidermal growth factor receptor or vascular endothelium growth factor receptor with gemcitabine-based chemotherapy in patients with advanced pancreatic cancer: a meta-analysis.
abstract: OBJECTIVE
  Several clinical trials have been published on gemcitabine-based chemotherapy with or without addition of agents against epidermal growth factor receptor (EGFR) or vascular endothelium growth factor receptor (VEGFR) in patients with advanced pancreatic cancer, however, with diverse results. The objective of this study was to perform a meta-analysis of the published trials.
  
  
  METHODS
  The database of CENTRAL, MEDLINE and EMBASE were searched. Eligible studies were randomized clinical trials (RCTs) that evaluated the efficacy and safety profile of adding targeted agents against EGFR or VEGFR to gemcitabine-based chemotherapy in patients with advanced pancreatic cancer. The primary outcome was overall survival (OS) while secondary outcomes included progression free survival (PFS) and overall response rate (ORR). Toxicity profiles were also assessed. Review Manager 5.1 was used to perform the analysis.
  
  
  RESULTS
  Results reported from 6 RCTs involving 2733 patients were included in the analysis. Compared to gemcitabine-based chemotherapy alone, addition of an agent against EGFR resulted in significant longer OS [Hazard ratios (HR) 0.89 (0.79-0.99), p = 0.04] and longer PFS [HR 0.87 (0.79-0.97), p = 0.01], but no significant difference in ORR [RR 1.18 (0.82-1.70), p = 0.36]. The addition of an agent against VEGFR resulted in higher ORR [RR 1.54 (1.03-2.30), p = 0.04], but no advantage in OS [HR 0.95 (0.83-1.09), p = 0.47] or PFS [HR 0.97 (0.77-1.23), p = 0.82].
  
  
  CONCLUSIONS
  Addition of an agent against EGFR to gemcitabine-based chemotherapy improved OS compared to gemcitabine-based chemotherapy alone in patients with advanced pancreatic cancer, while addition of an agent against VEGFR showed a modest improvement in ORR but not PFS and OS.
authors.affiliation: Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No 1665, Kongjiang Road, Yangpu District, Shanghai 200092, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tian
authors.forename: Wenping
authors.initials: W
authors.lastname: Ding
authors.forename: Sungkyoung
authors.initials: S
authors.lastname: Kim
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Xu
authors.forename: Minggui
authors.initials: M
authors.lastname: Pan
authors.forename: Siyu
authors.initials: S
authors.lastname: Chen
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols; D000077784:Axitinib; D000068258:Bevacizumab; D000068818:Cetuximab; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D007191:Indazoles / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors*; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007093:Imidazoles; D007191:Indazoles; D011799:Quinazolines; D003841:Deoxycytidine; D000068258:Bevacizumab; D000077784:Axitinib; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D040262:Receptors, Vascular Endothelial Growth Factor; D000068818:Cetuximab; D000093542:Gemcitabine
keywords: Epidermal growth factor receptor (EGFR); Gemcitabine; Meta-analysis; Pancreatic cancer; Vascular endothelium growth factor receptor (VEGFR)