Efficacy of different chemotherapy regimens in treatment of advanced or metastatic pancreatic cancer: A network meta-analysis

We performed a network meta-analysis (NMA) to compare the short- and long-term efficacy of Gemcitabine, Gemcitabine+S-1 (tegafur), Gemcitabine+nab-paclitaxel, Gemcitabine+Capecitabine, Gemcitabine+Cisplatin, FOLFIRINOX (oxaliplatin+irinotecan+fluorouracil+leucovorin), Gemcitabine+oxaliplatin, Gemcitabine+irinotecan, Gemcitabine+Exatecan, Gemcitabine+pemetrexed, Gemcitabine+5-FU, and S-1 in treating advanced or metastatic pancreatic cancer (PC). The odds radios (OR) or weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) were evaluated by a combination of direct evidence and indirect evidence. In total twenty studies were included in this paper. For short-term efficacy, the overall response rate (ORR) was lower for patients treated with Gemcitabine compared with Gemcitabine+S-1, Gemcitabine+Cisplatin, Gemcitabine+irinotecan and S-1. The ORR for FOLFIRINOX was higher compared with Gemcitabine, Gemcitabine+Capecitabine and Gemcitabine+Cisplatin. The disease control rate (DCR) for Gemcitabine was lower compared with Gemcitabine+S-1, Gemcitabine+Cisplatin, and FOLFIRINOX. For long-term efficacy, the 12-month overall survival (OS) rate for FOLFIRINOX was higher compared with Gemcitabine, Gemcitabine+Capecitabine, Gemcitabine+Cisplatin, Gemcitabine+irinotecan, Gemcitabine+Exatecan, and Gemcitabine+pemetrexed. The SUCRA revealed that FOLFIRINOX was relatively better in both short- and long-term efficacy, while Gemcitabine was relatively poorer. In both short- and long-term efficacy, FOLFIRINOX had the best short- and long-term efficacy among the 12 chemotherapy regimens while efficacy of Gemcitabine was relatively poorer in the treatment of advanced or metastatic PC.