Capecitabine combination chemotherapy for advanced pancreatic cancer: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHENG Jialei ¹ , Su Fang ² , Fang Xiang ³ , GAO Zhenyuan ² , WANG Zishu ² , ZHENG Rongshen ² ,  SUN Guoping ¹

1. Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P.R.China;
2. Department of Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233003, P.R.China;
3. Department of Gerontology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P.R.China;

Corresponding author：

SUN Guoping, Email: sung.p@ahmu.edu.cn

Keywords：

Advanced pancreatic cancer; Capecitabine; Gemcitabine; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.201803003

Video：

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Objective To evaluate the efficacy and safety of capecitabine combination chemotherapy for advanced pancreatic cancer. Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were searched to collect randomized controlled trials (RCTs) on capecitabine combination chemotherapy for advanced pancreatic cancer from inception to December, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were analyzed by using RevMan 5.3 software. Results Six RCTs were included. The results of meta-analysis showed that compared with the control group, capecitabine combination chemotherapy extended the overall survival (HR=0.86, 95%CI 0.77 to 0.96, P=0.006) and disease progression-free survival (HR=0.83, 95%CI 0.75 to 0.91, P=0.000 2). Moreover, the objective response rate was significantly increased in capecitabine combination chemotherapy (RR=1.64, 95%CI 1.27 to 2.11, P=0.000 1). The results of 3–4 toxic side effects of 6 RCTs indicated that the incidence of neutropenia, stomatitis and hand-foot syndrome of capecitabine combination chemotherapy were obviously higher than those in the control group (P<0.05). Conclusions Capecitabine combination chemotherapy extend the overall survival and disease progression-free survival, and improve the objective response rate. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

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1. 张师容, 靳伟, 刘亮, 等. 2017 年胰腺癌基础研究及诊疗新进展. 中国癌症杂志, 2018, 28(1): 1-10.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
3. Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer. Lancet, 2016, 388(10039): 73-85.
4. 中华医学会外科学分会胰腺外科学组. 胰腺癌诊治指南(2014). 中华外科杂志, 2014, 52(12): 881-887.
5. Ottaiano A, Capozzi M, De Divitiis C, et al. Gemcitabine mono-therapy versus gemcitabine plus targeted therapy in advanced pancreatic cancer: a meta-analysis of randomized phase III trials. Acta Oncol, 2017, 56(3): 377-383.
6. Cao C, Kuang M, Xu W, et al. Gemcitabine plus S-1: a hopeful frontline treatment for Asian patients with unresectable advanced pancreatic cancer. Jpn J Clin Oncol, 2015, 45(12): 1122-1130.
7. Irigoyen A, Gallego J, Guillén Ponce C, et al. Gemcitabine-erlotinib versus gemcitabine- erlotinib-capecitabine in the first-line treatment of patients with metastatic pancreatic cancer: Efficacy and safety results of a phase IIb randomised study from the Spanish TTD Collaborative Group. Eur J Cancer, 2017, 75: 73-82.
8. Lee HS, Chung MJ, Park JY, et al. A randomized multicenter phase III study of gemcitabine combined with capecitabine versus gemcitabine alone as first-line chemotherapy for advanced pancreatic cancer in South Korea. Medicine (Baltimore), 2017, 96(1): e5702.
9. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials, 1996, 17(1): 1-12.
10. Cunningham D, Chau I, Stocken DD, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol, 2009, 27(33): 5513-5518.
11. Herrmann R, Bodoky G, Ruhstaller T, et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol, 2007, 25(16): 2212-2217.
12. Scheithauer W, Schüll B, Ulrich-Pur H, et al. Biweekly high-dose gemcitabine alone or in combination with capecitabine in patients with metastatic pancreatic adenocarcinoma: a randomized phase II trial. Ann Oncol, 2003, 14(1): 97-104.
13. 王健, 赵云超, 韩娜. 吉西他滨联合卡培他滨与吉西他滨单药治疗晚期胰腺癌的疗效. 中国老年学杂志, 2011, 31(16): 3197-3198.
14. Middleton G, Palmer DH, Greenhalf W, et al. Vandetanib plus gemcitabine versus placebo plus gemcitabine in locally advanced or metastatic pancreatic carcinoma (ViP): a prospective, randomised, double-blind, multicentre phase 2 trial. Lancet Oncol, 2017, 18(4): 486-499.
15. Hammel P, Huguet F, van Laethem JL, et al. Effect of chemoradiotherapy vs. chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the lap07 randomized clinical trial. JAMA, 2016, 315(17): 1844-1853.
16. Ottaiano A, Capozzi M, De Divitiis C, et al. Gemcitabine mono-therapy versus gemcitabine plus targeted therapy in advanced pancreatic cancer: a meta-analysis of randomized phase III trials. Acta Oncol, 2017, 56(3):377-383.
17. Satoi S, Fujii T, Yanagimoto H, et al. Multicenter Phase II study of intravenous and intraperitoneal paclitaxel with S-1 for pancreatic ductal adenocarcinoma patients with peritoneal metastasis. Ann Surg, 2017, 265(2): 397-401.

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