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Cisplatin/gemcitabine or oxaliplatin/gemcitabine in the treatment of advanced biliary tract cancer: a systematic review.

Abstract
Cisplatin/gemcitabine association has been a standard of care for first-line regimen in advanced biliary tract cancer nevertheless oxaliplatin/gemcitabine regimen is frequently preferred. Because comparative effectiveness in clinical outcomes of cisplatin- versus oxaliplatin-containing chemotherapy is not available, a systematic review of studies assessing cisplatin/gemcitabine or oxaliplatin/gemcitabine chemotherapies in advanced biliary tract cancer was performed. Published studies evaluating cisplatin/gemcitabine or oxaliplatin/gemcitabine in advanced biliary tract cancer were included. Each study was weighted according to the number of patients included. The primary objective was to assess weighted median of medians overall survival (mOS) reported for both regimens. Secondary goals were to assess weighted median of medians progression-free survival (mPFS) and toxic effects were pooled and compared within each arm. Thirty-three studies involving 1470 patients were analyzed. In total, 771 and 699 patients were treated by cisplatin/gemcitabine and oxaliplatin/gemcitabine, respectively. Weighted median of mOS was 9.7 months in cisplatin group and 9.5 months in oxaliplatin group. Cisplatin-based chemotherapy was significantly associated with more grade 3 and 4 asthenia, diarrhea, liver toxicity, and hematological toxicity. Sensitivity analysis including only the studies with the standard regimen of cisplatin (25-35 mg/m(2) administered on days 1 and 8) showed that the weighted median of mOS increased from 9.7 to 11.7 months but Gem/CDDP regimen remained more toxic than Gemox regimen. These results suggest that the Gem/CDDP regimen with cisplatin (25-35 mg/m(2)) administered on days 1 and 8 is associated with survival advantage than Gemox regimen but with addition of toxicity.
AuthorsFrédéric Fiteni, Thierry Nguyen, Dewi Vernerey, Marie-Justine Paillard, Stefano Kim, Martin Demarchi, Francine Fein, Christophe Borg, Franck Bonnetain, Xavier Pivot
JournalCancer medicine (Cancer Med) Vol. 3 Issue 6 Pg. 1502-11 (Dec 2014) ISSN: 2045-7634 [Electronic] United States
PMID25111859 (Publication Type: Journal Article, Review, Systematic Review)
Copyright© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Chemical References
  • Organoplatinum Compounds
  • Oxaliplatin
  • Deoxycytidine
  • Cisplatin
  • Gemcitabine
Topics
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Biliary Tract Neoplasms (drug therapy)
  • Cisplatin (administration & dosage)
  • Deoxycytidine (administration & dosage, analogs & derivatives)
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Organoplatinum Compounds (administration & dosage)
  • Oxaliplatin
  • Randomized Controlled Trials as Topic
  • Gemcitabine

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