[Chemotherapy for advanced or metastatic pancreatic cancer: analysis of 43 randomized trials in 3 decades (1974-2002)].

Pancreatic cancer represents a major challenge to oncologists because of its high chemoresistant nature and dismal outcomes, especially in advanced diseases. Clinical trials on the effects of systemic chemotherapy for patients with advanced pancreatic cancer have not been shown to have consistent benefits. A systematic review and meta-analysis was therefore conducted to examine this issue. All randomized trials on chemotherapy treatment for advanced pancreatic cancer published since the 1970's were identified by means of Medline and other major oncology databases. Systematic review of all trials was carefully conducted and data from trials with similar designs and regimens were pooled and grouped together in the benefit outcome analyses. Data for 5,365 patients from 43 randomized controlled trials were identified. Survival benefit over best supportive care was demonstrated in 5-FU-based chemotherapy in 9 randomized trials. However, trials that comparing 5-FU or other cytotoxic agent alone versus 5-FU-based combinations did not show any statistical differences, nor were various 5-FU-combinations comparing among themselves. On the other hand, gemcitabine was shown to improve survival and clinical benefit responses better than 5-FU and other new agents. Overall, these results were encouraging and future research to explore means to optimize drug treatment (especially gemcitabine-based regimens) for advanced pancreatic cancer is warranted.