Evidence map›Paper›PMID 18373843›Full record

SynthesisBMC cancer2008

Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer.

Volker Heinemann, Stefan Boeck, Axel Hinke, Roberto Labianca, Christophe Louvet

Open access · goldAbstract readComparative StudyMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC cancer, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 167 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
167citing papers in PubMed, 12 pooled it
16.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

167 citing papers in PubMed, 12 syntheses or guidelines pooled it, 431 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Chemotherapy and radiotherapy for advanced pancreatic cancer.The Cochrane database of systematic reviews · 2018
    Pooled it
  4. Pooled it
  5. Guideline
  6. Pooled it
  7. Pooled it
  8. SEOM clinical guidelines for the treatment of pancreatic cancer.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2011
    Guideline
  9. Pooled it
  10. Pancreatic adenocarcinoma.Journal of the National Comprehensive Cancer Network : JNCCN · 2010
    Guideline
  11. Pancreatic cancer.BMJ clinical evidence · 2010
    Pooled it
  12. Pooled it
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. A randomized, placebo-controlled phase III trial of masitinib plus gemcitabine in the treatment of advanced pancreatic cancer.Annals of oncology : official journal of the European Society for Medical Oncology · 2015
    Trial
  18. Trial
  19. Trial
  20. Trial

107 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 2 countries.

Volker HeinemannDepartment of Internal Medicine III, Klinikum Grosshadern, University of Munich, Germany. volker.heinemann@med.uni-muenchen.de
Stefan Boeck
Axel Hinke
Roberto Labianca
Christophe Louvet
Azienda Ospedaliero Universitaria Ospedali Riuniti · ITHôpital Saint-Antoine · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSingle-agent gemcitabine (GEM) is a standard treatment for advanced and metastatic pancreatic cancer. This study examines the question whether GEM-based combination chemotherapy can further improve treatment efficacy.

methodsA meta-analysis was performed to evaluate randomized trials comparing GEM versus GEM+X (X = cytotoxic agent). Fifteen trials including 4465 patients were eligible for an analysis of overall survival, the primary end-point of this investigation.

resultsThe meta-analysis revealed a significant survival benefit for GEM+X with a pooled hazard ratio (HR) of 0.91 (95% CI: 0.85 - 0.97, p = 0.004). The overall test for heterogeneity resulted in p = 0.82 (I2 = 0%). The analysis of platinum-based combinations indicated a HR of 0.85 (95% CI: 0.76 - 0.96, p = 0.010), while for fluoropyrimidine-based combinations the HR was 0.90 (95% CI: 0.81 - 0.99, p = 0.030). No risk reduction was observed in the group of trials combining GEM with irinotecan, exatecan or pemetrexed (HR = 0.99). A meta-analysis of the trials with adequate information on baseline performance status (PS) was performed in five trials with 1682 patients. This analysis indicated that patients with a good PS had a marked survival benefit when receiving combination chemotherapy (HR = 0.76; 95% CI: 0.67 - 0.87; p < 0.0001). By contrast, application of combination chemotherapy to patients with an initially poor PS appeared to be ineffective (HR = 1.08; 95% CI: 0.90 - 1.29, p = 0.40).

conclusionThe meta-analysis of randomized trials indicated a significant survival benefit when GEM was either combined with platinum analogs or fluoropyrimidines. Based on a preliminary subgroup analysis (representing 38% of all patients included in this meta-analysis), pancreatic cancer patients with a good PS appear to benefit from GEM-based cytotoxic combinations, whereas patients with a poor PS seem to have no survival benefit from combination chemotherapy.

Indexed as

AminoacridinesAntimetabolites, AntineoplasticAntineoplastic Combined Chemotherapy ProtocolsCisplatinClinical Trials, Phase II as TopicClinical Trials, Phase III as TopicDeoxycytidineFemaleGemcitabineHumansMaleOrganoplatinum CompoundsOxaliplatinPancreatic NeoplasmsRandomized Controlled Trials as TopicSurvival AnalysisAminoacridinesAntimetabolites, AntineoplasticCisplatinDeoxycytidinefluoroquinacrineGemcitabineOrganoplatinum CompoundsOxaliplatin

Identifiers

PMID18373843
PMCPMC2292732
OpenAlexW1974922522

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.