title: Polychemotherapy or gemcitabine in advanced pancreatic cancer: a meta-analysis.
abstract: BACKGROUND
  Gemcitabine monotherapy is the cornerstone of treatment for advanced pancreatic cancer. To date, no clear survival benefit has been found when combination chemotherapy has been compared with gemcitabine alone, except in a few studies. This meta-analysis compared the efficacy of polychemotherapy with gemcitabine alone in advanced pancreatic cancer.
  
  
  METHODS
  Randomised trials comparing combination chemotherapy with gemcitabine alone were identified through electronic searches of PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. Overall survival, reported as the hazard ratio at the 95% confidence interval, was the primary outcome measure.
  
  
  RESULTS
  29 trials (19 phase III and 10 small randomised trials) that included 8421 patients were identified. Overall, polychemotherapy significantly improved overall survival (hazard ratio=0.87; 95% CI, 0.81-0.93; P<0.0001), progression-free survival (hazard ratio=0.77; 95% CI, 0.70-0.84; P<0.00001), and response rate (risk ratio=1.71; 95% CI, 1.42-2.07; P<0.00001) compared with gemcitabine alone.
  
  
  CONCLUSIONS
  Compared with gemcitabine monotherapy, combinations of two or more drugs (particularly those with novel agents or associated with >20% response rates and triplets) improved outcomes and response rate in advanced pancreatic cancer, and they could be considered a new standard of care in advanced settings.
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy. Electronic address: faupe@libero.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coinu
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
authors.forename: Karen
authors.initials: K
authors.lastname: Borgonovo
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
authors.forename: Mary
authors.initials: M
authors.lastname: Cabiddu
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Ghilardi
authors.affiliation: Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D017671:Platinum Compounds / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D001952:Bridged-Ring Compounds; D017671:Platinum Compounds; D043823:Taxoids; D003841:Deoxycytidine; C080625:taxane; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: First line; Gemcitabine; Meta-analysis; Overall survival; Pancreatic cancer; Polychemotherapy