Chemotherapy for advanced gallbladder cancer (GBC): A systematic review and meta-analysis

Background: The benefit from chemotherapy, specifically for patients with gallbladder cancer (GBC), has been poorly explored since GBC is mostly studied jointly with other biliary tract cancers (BTC). Methods: Eligible studies reporting outcome of palliative systemic chemotherapy for advanced GBC were identified through MEDLINE, cross-referencing and conferences (PROSPERO-CRD42019155745). Meta-analysis of proportions and calculation of pooled weighted means were performed. Results: 58 eligible studies (n = 1,986 patients); cisplatin/gemcitabine (33 % of patients), gemcitabine/oxaliplatin (14 %) or gemcitabine monotherapy (9%). Estimated pooled overall radiological response rate(ORR), and pooled weighted mean progression-free (PFS) and overall survivals (OS) were 23.2 % (95 %-CI 20.0-26.5) (I2: 52.5 % (p < 0.001)), 4.8 months (95 %-CI 4.3-5.2) and 8.3 months (95 %CI 7.6-8.9), respectively. Patients with non-GBC BTCs achieved a lower ORR than GBC [odds ratio 0.65 (95 % CI, 0.50- 0.84)]. Conclusions: GBC benefit from chemotherapy differs from other BTCs, with shorter PFS/OS despite higher ORR; new treatment options are urgently required for management of advanced GBC.

Automated summary

The study found that the benefit from chemotherapy for gallbladder cancer (GBC) differs from other biliary tract cancers (BTC), as GBC patients had a higher overall radiological response rate (ORR) but shorter progression-free survival (PFS) and overall survival (OS). New treatment options are urgently needed for the management of advanced GBC.