Toxicity of chemotherapy regimens in advanced and metastatic pancreatic cancer therapy: A network meta-analysis

This network meta-analysis is adopted in order to compare the toxicity of different chemotherapy regimens in the treatment of advanced/metastatic pancreatic cancer (PC). Randomized controlled trials (RCTs) about different chemotherapy regimens for advanced/metastatic PC were included in this network meta-analysis using Cochrane Library and PubMed electronic databases. The network meta-analysis was performed to combine direct and indirect evidence in order to calculate the odd ratios (OR) and draw a surface under the cumulative ranking (SUCRA) curve. A total of 19 RCTs were enrolled in this network meta-analysis including 12 chemotherapy regimens (Gemcitabine, Gemcitabine+S-1 [tegafur], Gemcitabine+nab-paclitaxel, Gemcitabine+Capecitabine, Gemcitabine+Cisplatin, FOLFIRINOX [oxaliplatin+irinotecan+fluorouracil+leucovorin], Gemcitabine+oxaliplatin, Gemcitabine+irinotecan, Gemcitabine+Exatecan, Gemcitabine+pemetrexed, Gemcitabine+5-FU, S-1). The incidence of anemia of Gemcitabine+Capecitabine regimen was higher compared with Gemcitabine regimen, Gemcitabine+pemetrexed regimen exhibited the highest incidence rates of anemia and neutropenia; while Gemcitabine+S-1, Gemcitabine+Cisplatin and FOLFIRINOX regimens exhibited the highest incidence rates of neutropenia. However, S-1 regimen exhibited lower incidence rates of leukopenia and thrombocytopenia. Moreover, the incidence rates of nausea/vomiting and rash of Gemcitabine+S-1 regimen were higher compared with Gemcitabine regimen, while Gemcitabine+Cisplatin regimen had the highest incidence rate of nausea/vomiting. This study demonstrated that the hematologic toxicity of S-1 regimen was the lowest, while Gemcitabine regimen exhibited the lowest incidence rate of non-hematologic toxicity, providing guidance for the treatment of advanced/metastatic PC.