Systematic review and Bayesian network meta-analysis of first-line chemotherapy regimens for advanced biliary tract cancer

Biliary tract cancers are aggressive malignant neoplasms with a dismal prognosis. Recent advances have expanded therapeutic options, but head-to-head comparisons between regimens remain limited. Systematic review and Bayesian network meta-analysis (NMA) of phase 2 or 3 randomized clinical trials published from 2000 to 2024 compared first-line chemotherapy regimens for unresectable locally advanced or metastatic BTC. The NMA synthesized data from 33 RCTs involving 7303 patients. Gemcitabine and cisplatin (GC) plus durvalumab, GC plus S1, gemcitabine and oxaliplatin (GO) plus panitumumab, and GO plus cetuximab demonstrated the greatest consistency in the surface under the cumulative ranking curve value for progression-free survival, overall survival, and objective response rate, making these the optimal regimens in terms of overall outcomes. These regimens also demonstrated a comparable risk of hematological toxic effects.