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To investigate the efficiency and safety profile of the addition of S-1 to gemcitabine (GEM)-based chemotherapy for advanced pancreatic cancer (APC).Computerized search was undertaken to identify randomized controlled trials of S-1 plus GEM versus GEM monotherapy in APC patients. The outcomes included overall survival (OS), progression-free survival (PFS), response rate, and toxicities.Five studies with 917 patients were included. Overall, there was a significant difference between the two regimens in terms of OS (HR=0.83, 95%CI=0.72-0.96, P=0.01), PFS (HR=0.64, 95%CI=0.56-0.74, P0.0001), and overall response rate (ORR; RR=2.36, 95%CI=1.73-3.22, P0.00001). Occurrence of grade 3/4 hematological toxicities (neutropenia, thrombocytopenia) and non-hematological toxicities (diarrhea, nausea/vomit, rush, stomatitis/mucositis) were significantly higher with GEM/S-1 treatment.This meta-analysis indicated a significant survival benefit with increased toxicity when S-1 was combined with GEM. GEM/S-1 might be an option of first-line chemotherapy for APC patients, at least in Asia.

Summary Aims To evaluate the efficiency and safety profile of raltitrexed-based chemotherapy in the treatment of advanced colorectal cancer. Methods An electronic search was undertaken to identify randomized controlled trials comparing raltitrexed-based regimen to 5-fluorouracil-based regimen in patients with advanced colorectal cancer. The outcomes included overall survival, overall response rate and toxicities. Results This meta-analysis included 11 studies with 4622 patients. Overall, there were no significant differences between the two regimens in terms of overall survival (HR = 1.06, 95% CI: 0.96–1.17, P = 0.23) or overall response rate (RR = 1.09, 95% CI: 0.86–1.38, P = 0.47). In subgroup analysis, patients in raltitrexed/oxaliplatin group had significantly higher partial response (RR = 1.53, 95% CI: 1.17–2.00, P = 0.002), overall response rate (RR = 1.42, 95% CI: 1.10–1.82, P = 0.006), disease control rate (RR = 1.16, 95% CI: 1.04–1.29, P = 0.009) and lower progressive disease (RR = 0.61, 95% CI: 0.45–0.84, P = 0.002) when compared to 5-fluorouracil/leucovorin/oxaliplatin group. Occurrence of severe anemia (RR = 2.23, 95% CI: 1.38–3.59, P = 0.0001), asthenia (RR = 2.29, 95% CI: 1.36–3.84, P = 0.002), hepatic disorders (RR = 7.51, 95% CI: 1.30–43.56, P = 0.02), and nausea/vomit (RR = 1.70, 95% CI: 1.03–2.81, P = 0.04) were significantly higher with the raltitrexed arm treatment, while frequencies of grade 3/4 alopecia (RR = 0.36, 95% CI: 0.26–0.50, P P Conclusions Raltitrexed-based chemotherapy regimen leads to an equivalent overall survival and response rates with acceptable toxicities compared to traditional 5-fluorouracil-based regimen in patients with advanced colorectal cancer. Raltitrexed can be a treatment option for these patients when 5-fluorouracil-based regimens are not tolerated or inappropriate.