title: The addition of S-1 to gemcitabine-based chemotherapy improves survival with increased toxicity for patients with advanced pancreatic cancer: combined meta-analysis of efficacy and safety profile.
abstract: OBJECTIVE
  To investigate the efficiency and safety profile of the addition of S-1 to gemcitabine (GEM)-based chemotherapy for advanced pancreatic cancer (APC).
  
  
  METHODS
  Computerized search was undertaken to identify randomized controlled trials of S-1 plus GEM versus GEM monotherapy in APC patients. The outcomes included overall survival (OS), progression-free survival (PFS), response rate, and toxicities.
  
  
  RESULTS
  Five studies with 917 patients were included. Overall, there was a significant difference between the two regimens in terms of OS (HR=0.83, 95%CI=0.72-0.96, P=0.01), PFS (HR=0.64, 95%CI=0.56-0.74, P<0.0001), and overall response rate (ORR; RR=2.36, 95%CI=1.73-3.22, P<0.00001). Occurrence of grade 3/4 hematological toxicities (neutropenia, thrombocytopenia) and non-hematological toxicities (diarrhea, nausea/vomit, rush, stomatitis/mucositis) were significantly higher with GEM/S-1 treatment.
  
  
  CONCLUSIONS
  This meta-analysis indicated a significant survival benefit with increased toxicity when S-1 was combined with GEM. GEM/S-1 might be an option of first-line chemotherapy for APC patients, at least in Asia.
authors.affiliation: Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Wenzhou 325000, Zhejiang Province, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Wenzhou 325000, Zhejiang Province, PR China.
authors.forename: Qing-ke
authors.initials: QK
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Wenzhou 325000, Zhejiang Province, PR China.
authors.forename: Wan-dong
authors.initials: WD
authors.lastname: Hong
authors.affiliation: Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Wenzhou 325000, Zhejiang Province, PR China.
authors.forename: Jin-ming
authors.initials: JM
authors.lastname: Wu
authors.affiliation: Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road, Wenzhou 325000, Zhejiang Province, PR China. Electronic address: sxcdr1979@126.com.
authors.forename: Xue-cheng
authors.initials: XC
authors.lastname: Sun
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use* / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000633:toxicity; D018572:Disease-Free Survival; D004338:Drug Combinations; D006801:Humans; D010094:Oxonic Acid / Q000008:administration & dosage* / Q000633:toxicity; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D005641:Tegafur / Q000008:administration & dosage* / Q000633:toxicity; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine