Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2022; 14(10): 2061-2076
Published online Oct 15, 2022. doi: 10.4251/wjgo.v14.i10.2061
Combining of chemotherapy with targeted therapy for advanced biliary tract cancer: A systematic review and meta-analysis
Xue-Song Bai, Sheng-Nan Zhou, Yi-Qun Jin, Xiao-Dong He
Xue-Song Bai, Sheng-Nan Zhou, Xiao-Dong He, Department of General Surgery, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
Yi-Qun Jin, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Bai XS conceived the study idea; Bai XS, Zhou SN and Jin YQ conducted the literature searches and review of studies, performed data extraction, interpreted data analyses and drafted manuscripts; He XD advised on data interpretation, advised on ethodologies and helped performed statistical analysis of the manuscript; All authors interpreted data and wrote the report. All authors contributed to the article and approved the submitted version.
Supported by China Academy of Medical Science Innovation Fund for Medical Sciences, CIFMS, No. 2021-I2M-1-022-2021-S4.
Conflict-of-interest statement: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dong He, Doctor, MD, Professor, Department of General Surgery, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. hxdpumch@163.com
Received: June 8, 2022
Peer-review started: June 8, 2022
First decision: August 20, 2022
Revised: September 4, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: October 15, 2022
Processing time: 127 Days and 20.6 Hours
ARTICLE HIGHLIGHTS
Research background

The prognosis of patients with advanced biliary tract cancer (BTC) is poor. The clinical efficacy of combining chemotherapy (CT) with targeted therapy (TT) as first-line treatment remains controversial.

Research motivation

Currently, TT based on actionable genetic alterations in BTC are being extensively explored. However, the clinical efficacy of combination CT with TT as first-line treatment for advanced BTC is unclear. A meta-analysis is necessary to systematically and comprehensively evaluate the clinical value of TT for advanced BTC.

Research objectives

The purpose of this meta-analysis was to explore the value of CT combined with TT as first-line treatment for advanced BTC.

Research methods

We systematically searched PubMed, EMBASE, ClinicalTrials, Scopus, and the Cochrane Library databases to screen and include randomized clinical trials (RCTs) on gemcitabine-based CT alone vs the combination of TT and CT as first-line treatment for advanced BTC. Review Manager 5.4.1 software was used to conduct the statistical analysis. Objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were analyzed as main outcomes. Subgroup analyses based on different targeted agents, CT regimens and tumor locations were performed.

Research results

Our meta-analysis showed a significant improvement in ORR in patients treated with CT + TT compared to those treated with CT alone (P = 0.007), but no difference in PFS or OS. Similar trends were observed in the subgroup treated with agents targeting EGFR (P = 0.004). Notably, patients who received a CT regimen of gemcitabine + oxaliplatin in the CT + TT arm had both a higher ORR (P = 0.004) and longer PFS (P = 0.03) than those in the CT-only arm. Moreover, patients with cholangiocarcinoma treated with CT + TT had significantly increased ORR and PFS.

Research conclusions

Our study is the first meta-analysis of RCTs to evaluate the efficacy of the combining TT with standard CT as first-line treatment for advanced BTC. The meta-analysis has demonstrated that CT + TT is a promising first-line treatment for advanced BTC that leads to improved clinical outcomes.

Research perspectives

In the future, more clinical studies are needed to explore the role of TT for advanced BTC. In addition, attention should be paid on the interactions of CT regimen and tumor location for assessing the clinical efficacy of TT in advanced BTC.