A Systematic Review And Meta-analysis Of The Safety And Efficacy Of S-1 Combined With Nab-paclitaxel In The Treatment Of Elderly Patients With Advanced Pancreatic Cancer

Objective: To evaluate the safety and efficacy of S-1 and S-1 combined with nab paclitaxel in the treatment of elderly patients with advanced pancreatic cancer by meta-analysis,so as to provide high-level evidence-based medicine for the chemotherapy of elderly patients with pancreatic ductal adenocarcinoma.Method:Pubmed,Embase,Cochrane Central Library,Sinomed,CNKI,Wanfang Data Knowledge Service Platform,VIP were searched without time limit according to inclusion criteria.In addition,relevant conference literatures at home and abroad were searched.Rev Man(Version 5.3)software was used for data extraction and meta-analysis.ORR and DCR were used to evaluate therapeutic effect while side effect including leukopenia,thrombocytopenia,neurotoxicity,vomit and alopecia were extracted for evaluation.Results:4 studies,three randomized controlled trials and one case-control study comprising 308 elderly patients with metastatic or locally advanced pancreatic adenocarcinoma were included in the analysis.151 patients underwent S-1monotherapy and 157 received S-1 combined nab-paclitaxel.Meta-analysis indicated that compared to S-1 monotherapy,S-1 combined nab-paclitaxel had higher ORR(OR2.25,95%CI:1.42-3.55,p=0.0005)and DCR(OR 2.94,95%CI:1.55-5.58,p=0.0009).The adverse reaction of leukopenia was higher in combined therapy group(OR 1.85,95%CI:1.09-3.13,p=0.02),no significant difference was found in thrombocytopenia,neurotoxicity,vomit and alopecia between the two groups(p>0.05).Conclusion: Nab-paclitaxel plus S-1 was more efficient in terms of ORR and DCR than S-1 monotherapy in elderly PDAC patients while the side effect was controllable with only higher probability of leukopenia.Thus,combined nab-paclitaxel and S-1 could be safely used in elderly patients.However,Only two groups of studies reported the results of survival,so the meta-analysis of survival could not be carried out,but the survival of the experimental group was longer than that of the control group.Due to the limitations of the number and quality of included studies,the above conclusions still need to be further verified by large sample and high-quality RCT.