SynthesisJAMA network open2026
First-Line Chemotherapy Regimens for Unresectable Locally Advanced or Metastatic Biliary Tract Cancer: A Systematic Review and Bayesian Network Meta-Analysis.
Synthesis in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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.
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.
Who cites it
1 citing paper in PubMed.
- Fibroblast-associated TPM2 links cell-matrix remodeling to EMT-Notch signaling and gemcitabine resistance in intrahepatic cholangiocarcinoma.Cancer biology & therapy · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Biliary tract cancers (BTCs) are aggressive malignant neoplasms with a dismal prognosis. Recent advancements, including immunotherapy and targeted therapies, have expanded therapeutic options, yet head-to-head comparisons between regimens remain limited. Objective: To conduct a comprehensive network meta-analyses (NMA) to include latest advances in BTC therapy to guide clinical practice. Data Sources: PubMed, Embase, and Cochrane Central were searched for randomized clinical trials (RCT) from 2000 to 2024, with manual updates through August 2025 and conference abstracts and ClinicalTrials.gov screened. Study Selection: Phase 2 to 3 RCTs of unresectable, locally advanced, or metastatic BTC reporting progression-free survival (PFS) or overall survival (OS) were eligible. Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Two reviewers independently extracted data, resolving discrepancies with a third. Data were pooled with a fixed-effect model. Main Outcomes and Measures: Primary outcomes were PFS and OS; secondary outcomes included objective response rate (ORR) and grade 3 to 4 adverse events. Results: This systematic review and bayesian NMA synthesized data from 33 RCTs involving 7303 patients (median [IQR] age, 64 [63-65] years; 3704 [51.5%] male). Compared with gemcitabine plus cisplatin (GC), GC plus sintilimab plus anlotinib (hazard ratio [HR], 0.47; 95% CI, 0.28-0.80), GC plus S-1 (HR, 0.75; 95% CI, 0.59-0.97), and GC plus durvalumab (HR, 0.80; 95% CI, 0.66-0.97) were associated with highest PFS benefits. Capecitabine plus oxaliplatin (HR, 0.64; 95% CI, 0.44-0.92), GC plus durvalumab (HR, 0.71; 95% CI, 0.61-0.84), and gemcitabine plus oxaliplatin (GO) (HR, 0.78; 95% CI, 0.63-0.96) were associated with improved OS. ORR was highest with GC plus S-1 (odds ratio [OR], 4.13; 95% CI, 2.20-7.70), GC plus cediranib (OR, 3.20; 95% CI, 1.40-7.20), and GC plus durvalumab (OR, 1.60; 95% CI, 1.10-2.28) compared with GC. Toxicity profiles showed no significant hematological differences between regimens, but nonhematological risks varied. Overall, GC plus durvalumab, GC plus S-1, GO plus panitumumab, and GO plus cetuximab showed the greatest consistency in the surface under the cumulative ranking curve value for PFS, OS, ORR, and safety. Conclusions and relevance: This NMA establishes GC plus durvalumab and GC plus S-1 as potential leading first-line options for advanced BTC due to a consistent clear benefit in PFS, OS, ORR, and safety. This study also establishes that GC remains among the top regimens, as most other therapy lacked a clear superior benefit or were associated with worse PFS or OS compared with GC.
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