Clinical outcomes and safety comparison of gemcitabine plus cisplatin, capecitabine monotherapy, and gemcitabine plus oxaliplatin in the management of gallbladder carcinoma: a comprehensive meta-analysis

Abstract

Introduction: The utilization of chemotherapy treatment (CT) in the context of biliary tract cancers (BTC) remains a subject of considerable debate. To date, no comprehensive efficacy assessment has been conducted to directly compare the outcomes of chemotherapy (CT) in the patient population. It is worth noting that recent years have witnessed notable advancements in chemotherapy interventions for BTC. However, it is imperative to underscore that further research and investigation are necessary to comprehensively understand the full scope of treatment options and their relative effectiveness in addressing this challenging disease. Method: We searched the databases of PubMed, Biomed, Scholarly, and The Cochrane Library to find published publications that were relevant. We selected RCTs with patients with BTC undergoing adjuvant chemotherapy for our systematic analysis, which covered publications from 2010 to 2022. Indirect comparisons of overall survival (OS), progression-free survival (PFS), severe adverse events (SAE), and overall adverse events (OAE) were conducted using meta-analysis methods. Different chemotherapy treatments were selected. We employed a random-effects model for aggregating the data. Result: A total of 4395 individuals from 18 trials were examined, all of whom got the chemotherapy of our choosing. The findings of the indirect comparison showed that there was no discernible increase in overall survival for either Capecitabine plus Gemcitabine plus Oxaliplatin or Gemcitabine plus Cisplatin. The hazard ratios (hrs) for each combination were 1.69 [95% (CI): 1.17 to 2.44, 1.92 [95% (CI): 0.98 to 3.77, and 0.93 [95% (CI): 0.69 to 1.25], respectively. Likewise, there was no discernible increase in PFS among the three distinct medication categories under scrutiny. Despite this, gemcitabine + oxaliplatin continues to be more effective. Conclusion: We did not find any statistically significant improvements in OS or PFS for any of the three medication groups in the current analysis. Because of its better effectiveness, gemcitabine + oxaliplatin can be regarded the standard of therapy in the adjuvant scenario until more prospective studies are completed.