Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews

Biliary tract neoplasms; Biological therapy; ImmunotherapyNeoplàsies de les vies biliars; Teràpia biològica; ImmunoteràpiaNeoplasias de las vias biliares; Terapia biológica; InmunoterapiaBackground: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs. Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome. Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55–0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79–0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87–1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28–1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed. Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.This study is funded through a grant from Instituto de Salud Carlos III (PI18/00034), co-financed by funds from the European Regional Development Fund

Evaluación y abordaje de la fibromialgia: actualización de las evidencias científicas

Fibromialgia; Revisión sistemática; Guías de práctica clínicaFibromiàlgia; Revisió sistemàtica; Guies de pràctica clínicaFibromyalgia; Systematic review; Clinical Practice GuidelinesEl objetivo es desarrollar un documento de síntesis de la literatura científica que identifique, evalúe y resuma la mejor evidencia disponible referente a la FM: diagnóstico, pruebas complementarias, tratamiento. Presentar datos epidemiológicos de la FM a nivel estatal y europeo.L'objectiu és desenvolupar un document de síntesi de la literatura científica que identifiqui, avaluï i resumeixi la millor evidència disponible referent a la FM: diagnòstic, proves complementàries, tractament. Presentar dades epidemiològiques de la FM a nivell estatal i europeu.To offer a summary of the scientific literature, presenting the best available evidence regarding the diagnosis and treatment of FM and the complementary tests that should be administered. To provide epidemiological data on FM in Spain and in Europe as a whole

Eficacia, seguridad y utilidad de la genisteína en pacientes con síndrome de Sanfilippo

Genisteína; Síndrome de Sanfilippo; Sistema Nacional de SaludGenisteïna; Síndrome de Sanfilippo: Sistema Nacional de SalutGenistein; Sanfilippo disease; National Health SystemAntecedentes La genisteína es una terapia de reducción del sustrato propuesta para la mucopolisacaridosis tipo III (MPS III) o enfermedad de Sanfilippo. Objetivos Evaluar la eficacia, la seguridad y la utilidad de la genisteína en pacientes con MPS III con el fin de valorar la incorporación de la genisteína a la cartera común de servicios del Sistema Nacional de Salud (SNS). Métodos Revisión de la literatura científica elaborada a partir de un protocolo preespecificado, de acuerdo con directrices metodológicas estandarizadas. Informe de los hallazgos de la revisión de acuerdo con la declaración PRISMA. En enero de 2018 se diseñó y ejecutó una búsqueda en bases de datos bibliográficos, registros de estudios en curso y fuentes de información específicos de enfermedades raras. Se incluyeron estudios sin limitación de diseño en los que se evaluara el efecto de la genisteína en cualquier dosis y formato de administración en personas de cualquier edad con MPS III. A partir de dos investigadores se seleccionaron de manera independiente los estudios a incluir en el informe, y se evaluaron críticamente con herramientas de valoración del riesgo de sesgo de ensayos clínicos y de valoración de la calidad metodológica de los ensayos no controlados y estudios observacionales. Se extrajeron los datos descriptivos de los estudios y los resultados referidos a los desenlaces de interés de la revisión. Se recopilaron los hallazgos de la revisión para los principales desenlaces de interés en tablas de síntesis de la evidencia, en las que se incluyó una clasificación de la calidad de la evidencia. Finalmente, se elaboraron conclusiones sobre la inclusión de la genisteína en la cartera común de servicios del SNS junto a la identificación de lagunas de conocimiento. Resultados La búsqueda ofreció 837 referencias de las cuales se incluyeron 10 estudios (2 ensayos aleatorizados, 6 ensayos no controlados, 1 observacional no controlado y 1 reporte de caso). Los estudios incluyeron un total de 162 personas con un diagnóstico de MPS III. La mayoría de los estudios evaluaron una dosis baja de genisteína (entre los 5 y los 15 mg/kg/día) y solo dos estudios administraron una dosis alta de genisteína pura sintética (150 mg/kg/día). La duración del tratamiento fue variable en los estudios, entre 6 meses y 3 años. Todos los estudios valoraron los resultados inmediatamente después del tratamiento. Las dosis bajas de genisteína mostraron mejoras de poca o nula relevancia clínica en escalas neurocognitivas a los 12 meses de tratamiento (calidad de la evidencia muy baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Un ensayo clínico aleatorizado no mostró diferencias entre una dosis de 10 mg/kg/día de genisteína y placebo en una escala de comportamiento a los 6 meses de tratamiento, ni en ninguna de sus subescalas. Una extensión del estudio mostró que los pacientes tratados con genisteína mejoraban en la subescala de ansiedad tras un año de seguimiento (calidad de la evidencia baja, motivada por la imprecisión de los resultados y su heterogeneidad). Los estudios sobre dosis bajas de genisteína no describieron efectos adversos (calidad de la evidencia baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Un ensayo clínico no controlado no mostró diferencias en una escala de discapacidad al comparar las puntuaciones entre el inicio del estudio y las de los 12 meses de tratamiento con dosis altas de genisteína (calidad de la evidencia muy baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Este ensayo solamente registró nueve eventos adversos graves, de los cuales solo uno fue valorado como posiblemente relacionado con la genisteína. La mayoría de los eventos adversos no graves identificados se consideraron asociados con el trastorno subyacente (calidad de la evidencia baja, motivada por la imprecisión de los resultados). Conclusiones La dosis baja de genisteína ha mostrado una nula relevancia clínica mientras que los datos sobre la dosis alta son insuficientes. Los resultados consistentemente negativos sobre variables fisiológicas en las dosis bajas del tratamiento sugieren que no es apropiado realizar más estudios con estas dosis. En la actualidad está pendiente la publicación de los resultados de un ensayo clínico aleatorizado controlado con placebo (EudraCT 2013-001479- 18) de la dosis de genisteína de 150 mg/kg/día que tiene como variable principal de interés el nivel de heparán sulfato en líquido cefalorraquídeo. Si los resultados de este estudio fueran negativos, probablemente no estaría justificado seguir investigando sobre el posible beneficio del tratamiento. Aun si los resultados fueran positivos, se deberían realizar estudios adicionales que evaluaran el impacto de la dosis alta en desenlaces importantes para los pacientes, como los desenlaces comportamentales o neurocognitivos. Con los datos disponibles en la actualidad en la literatura, se concluye que la genisteína no debe incluirse en la cartera común de servicios del SNS. Con relación a la práctica clínica, se concluye que los profesionales sanitarios deberían conocer la limitada evidencia sobre el efecto de la genisteína en la MPS III e informar a las familias de personas con MPS III de la nula relevancia clínica de la dosis baja de genisteína y la ausencia de datos sobre el impacto de la dosis alta. Esta información debe servir de base para que los padres puedan tomar una decisión informada e individualizada en relación con el uso de la genisteína.Background Genistein is a substrate reduction therapy proposed for the treatment of mucopolysaccharidosis type III (MPS III), or Sanfilippo disease. Objectives To assess the efficacy, safety and usefulness of genistein in patients with MPS III in order to evaluate its possible incorporation into the service portfolio of the Spanish National Health System (NHS). Methods Review of the scientific literature based on a pre-specified protocol and following standardized methodological guidelines. The findings were reported in accordance with the PRISMA statement. In January 2018, bibliographic databases, registers of ongoing studies and specific information sources were searched for rare diseases. Studies evaluating the effect of genistein at any dose and presentation, in individuals of any age with MPS III were included, without limitations on design. Two investigators independently selected the studies to be included in the review, and evaluated them critically using a risk of bias assessment tool specific for clinical trials and a methodological quality assessment tool for uncontrolled trials and observational studies. Descriptive data from the studies and the results for the outcomes of interest of the review were extracted. The findings of the review for the main outcomes of interest are compiled in Summary of Evidence tables, which also include a classification of the quality of the evidence. Finally, the conclusions regarding the inclusion of genistein in the Spanish NHS service portfolio are presented and current knowledge gaps are identified. Results The search retrieved 837 references, from which 10 studies were included (two randomized trials, six uncontrolled clinical trials, one uncontrolled observational study and one case report). The studies included a total of 162 individuals with a diagnosis of MPS III. Most studies evaluated a low dose of genistein (between 5 and 15 mg/kg/day) and only two administered a high dose of synthetic pure genistein (150 mg/kg/day). Duration of genistein treatment in the studies varied between six months and three years, and all studies assessed the results immediately after treatment. Low doses of genistein showed improvements on neurocognitive scales of little or no clinical relevance after 12 months of treatment (very low quality of evidence, due to the methodological limitations of the studies and the imprecision of the results). A randomized clinical trial showed no difference on a behavioural scale (or on any of its subscales) between a dose of 10 mg/kg/day of genistein and placebo after six months of treatment. An extension of the study showed that patients treated with genistein presented improvements on the anxiety subscale after one year of followup (low quality of evidence, due to the imprecision of the results and their heterogeneity). Studies of low doses of genistein did not describe adverse effects (low quality of evidence, due to methodological limitations and imprecise results). An uncontrolled clinical trial did not show differences on a disability scale when comparing the change in scores between baseline and after 12 months of treatment with high doses of genistein (very low quality of evidence, due the methodological limitations of the studies and the imprecision of the results). This trial recorded only nine serious adverse events, of which only one was determined as possibly related to genistein. The majority of nonserious adverse events identified were attributed to the underlying disorder (low quality of evidence, due to the imprecision of the results). Conclusions: Low doses of genistein show no clinical relevance, while the data on high doses are insufficient. The consistently negative results for physiological variables with low doses of the treatment argue against the performance of further studies with these doses. The publication of the results of a randomized placebo-controlled clinical trial (EudraCT 2013-001479-18) testing the effects of a genistein dose of 150 mg/kg/day on the level of heparan sulfate in cerebrospinal fluid as the main variable is still pending. If the results of this study are negative, there would be no justification for continuing to investigate the possible benefits of the treatment. Even if the results were positive, additional studies would be needed to evaluate the impact of high doses on patient-important outcomes, such as behavioural or neurocognitive outcomes. Based on the data currently available in the literature, we do not support the inclusion of genistein in the Spanish NHS service portfolio. With regard to clinical practice, we conclude that health professionals should be aware of the limited evidence on the effect of genistein in MPS III; they should inform families of the lack of clinical relevance of low doses of genistein, and of the absence of data on the impact of high doses. This information should serve as a basis for parents to make an informed and individualized decision regarding its use

Thromboprophylaxis in elective spinal surgery

Supplemental Digital Content is available in the text Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. Patients: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). Intervention: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario

Evaluación y abordaje de síndrome de fatiga crónica: actualización de las evidencias científicas

Síndrome de fatiga crónica; Revisión sistemática; Guías de práctica clínicaSíndrome de fatiga crònica; Revisió sistemàtica; Guies de pràctica de clínicaChronic fatigue syndrome; Systematic reviews; Practice guidelinesRevisión sistemática de guías de práctica clínica (GPC), informes de evaluación de tecnologías sanitarias (ETS) y revisiones sistemáticas (RS) publicadas con posterioridad al informe técnico de AQuAs (2011) sobre el diagnóstico y tratamiento del SFC. Búsqueda exhaustiva de la literatura (hasta mayo 2016) en repositorios de GPC e informes de ETS, y en las bases de datos bibliográficas Medline, EMBASE y Cochrane Library. También se consultaron fuentes secundarias como UpToDate y Clinical Evidence. Evaluación de la calidad metodológica de los documentos seleccionados mediante el apartado metodológico del instrumento instrumento Appraisal of Guidelines Research and Evaluation - AGREE II y la escala Assessment of Multiple SysTemAtic Reviews - AMSTAR. Se han identificado estudios que reportan la prevalencia del SFC en los Estados Unidos y algunos países de Europa, pero ninguna en España. La evidencia identificada a fecha de mayo de 2016 es de calidad metodológica variable. El volumen de evidencia es limitado para el SFC. En SFC se ha identificado un informe de evaluación (Smith 2014) con fecha de búsqueda 2014, además del informe AQuAS 2011. No se han iden- 10 INFORMES, ESTUDIOS E INVESTIGACIÓN tificado nuevos criterios diagnósticos o propuestas de pruebas complementarias para la determinación de SFC. Se han incluido 8 revisiones sistemáticas de la literatura que evalúan tratamientos del SFC, 1 de ellas es un overview que evalúa tratamientos farmacológicos y no farmacológicos, y las 7 restantes evalúan exclusivamente tratamientos no farmacológicos.Systematic review of clinical practice guidelines (CPG), evaluation reports  of health technologies (ETS) and systematic reviews (SR) published  after the technical report of AQUAs (2011) on the diagnosis  and treatment of CFS. Comprehensive literature search (up to  May 2016) in CPG repositories and STD reports, and in the databases of  bibliographic data Medline, EMBASE and Cochrane Library. I also know  They consulted secondary sources such as UpToDate and Clinical Evidence. Evaluation  of the methodological quality of the documents selected through  the methodological section of the Instrument instrument Appraisal of  Guidelines Research and Evaluation - AGREE II and the Assessment scale  of Multiple SysTemAtic Reviews - AMSTAR.    Studies have been identified that report the prevalence of CFS in the United States  United and some countries in Europe, but none in Spain.  The evidence identified as of May 2016 is of methodological quality  variable. The volume of evidence is limited for CFS.  In CFS an evaluation report has been identified (Smith 2014) with  2014 search date, in addition to the AQuAS 2011 report.  10 REPORTS, STUDIES AND RESEARCH  new diagnostic criteria or proposals for complementary tests  for the determination of SFC. 8 systematic reviews have been included  of the literature evaluating CFS treatments, 1 of them is a  overview that evaluates pharmacological and non-pharmacological treatments, and  The remaining 7 evaluate exclusively non-pharmacological treatments.Revisió sistemàtica de guies de pràctica clínica (GPC), informes d'avaluació  de tecnologies sanitàries (ETS) i revisions sistemàtiques (RS) publicades  amb posterioritat a l'informe tècnic de aquas (2011) sobre el diagnòstic  i tractament de la SFC. Cerca exhaustiva de la literatura (fins  maig 2016) en repositoris de GPC i informes de MTS, i en les bases de  dades bibliogràfiques Medline, EMBASE i Cochrane Library. també es  van consultar fonts secundàries com UpToDate i Clinical Evidence. avaluació  de la qualitat metodològica dels documents seleccionats mitjançant  l'apartat metodològic de l'instrument instrument Appraisal of  Guidelines Research and Evaluation - AGREE II i l'escala Assessment  of Multiple Systematic Reviews - Amstar.    S'han identificat estudis que reporten la prevalença de la SFC en els Estats  Units i alguns països d'Europa, però cap a Espanya.  L'evidència identificada a data de maig de 2016 és de qualitat metodològica  variable. El volum d'evidència és limitat per la SFC.  En SFC s'ha identificat un informe d'avaluació (Smith 2014) amb  data de cerca 2014, a més de l'informe aquas 2011. No s'han iden-  10 INFORMES, ESTUDIS I RECERCA  tificat nous criteris diagnòstics o propostes de proves complementàries  per a la determinació de SFC. S'han inclòs 8 revisions sistemàtiques  de la literatura que avaluen tractaments de la SFC, 1 d'elles és un  overview que avalua tractaments farmacològics i no farmacològics, i les  7 restants avaluen exclusivament tractaments no farmacològics

Evaluación y abordaje de la fibromialgia y el síndrome de fatiga crónica

Fibromialgia; Síndrome de la fatiga crónica; Revisión sistemáticaFibromyalgia; Chronic fatigue syndrome; Systematic reviewFibromiàlgia; Síndrome de la fatiga crònica; Revisió sistemàticaLos objetivos de este documento son: desarrollar un documento de síntesis de la literatura científica que identifique, evalúe y resuma la mejor evidencia disponible referente a los ámbitos de evaluación del ICAM para la FM y el SFC: diagnóstico, pruebas complementarias y tratamiento. Este informe ofrecerá la base de evidencia sobre la que se pueda fundamentar una actualización de la guía de evaluación del ICAM para la FM y el SFC de 2009 y presentar datos epidemiológicos de las dos condiciones a nivel estatal y europeo

Comparative analysis of systemic oncological treatments and best supportive care for advanced gastresophageal cancer : A comprehensive scoping review and evidence map

Altres ajuts: acords transformatius de la UABTo identify, describe, and organize the available evidence regarding systemic oncological treatments compared to best supportive care (BSC) for advanced gastresophageal cancer. We conducted a thorough search across MEDLINE (PubMed), EMbase (Ovid), The Cochrane Library, Epistemonikos, PROSPERO, and Clinicaltrials.gov. Our inclusion criteria encompassed systematic reviews, randomized controlled trials, quasi-experimental and observational studies involving patients with advanced esophageal or gastric cancer receiving chemotherapy, immunotherapy or biological/targeted therapy compared to BSC. The outcomes included survival, quality of life, functional status, toxicity, and quality of end-of-life care. We included and mapped 72 studies, comprising SRs, experimental and observational designs, 12 on esophageal cancer, 51 on gastric cancer, and 10 both locations. Most compared schemes including chemotherapy (47 studies), but did not report therapeutic lines. Moreover, BSC as a control arm was poorly defined, including integral support and placebo. Data favor the use of systemic oncological treatments in survival outcomes and BSC in toxicity. Data for outcomes including quality of life, functional status, and quality of end-of-life care were limited. We found sundry evidence gaps specifically in assessing new treatments such as immunotherapy and important outcomes such as functional status, symptoms control, hospital admissions, and the quality of end-life care for all the treatments. There are important evidence gaps regarding new for patients with advanced gastresophageal cancer and the effect of systemic oncological treatments on important patient-centered outcomes beyond survival. Future research should clearly describe the population included, specifying previous treatments and considering therapeutic, and consider all patient-centered outcomes. Otherwise, it will be complex to apply research results into practice

Piloting the informed health choices resources in Barcelona primary schools: A mixed methods study

IntroductionThe main objective of the Informed Health Choices (IHC) project is to teach people to assess treatment claims and make informed health choices. For this purpose, the IHC learning resources were developed for primary school children. The aim of this study is to explore students' and teachers' experience when using the IHC resources in primary schools in Barcelona (Spain). MethodsWe conducted a mixed methods study for piloting the IHC resources in a convenience sample of primary schools in Barcelona. The intervention included a workshop with teachers, and nine lessons with students. We collected data using multiple approaches. We performed quantitative and qualitative analyses, and integrated the findings in a joint display. Finally, we formulated recommendations for using the IHC resources in this setting. ResultsTwo schools, with a total of 143 students in 4th and 5th grade and six teachers, participated in the study. One school followed the suggested IHC teaching plan and competed all the lessons; the other school modified the plan substantially and did not complete all the lessons. Overall, students and teachers from both schools understood, were interested in, and were able to apply the content of the lessons. During the lessons, the textbook was useful for students; nevertheless, for the teachers, the usefulness of the IHC resources was variable. Teachers adapted the IHC resources to increase student participation and used Information and Communications Technologies tools. We observed more facilitators than barriers to teach the lessons. The teachers suggested some ideas to improve the lessons based on activities they developed and implemented. The integration analysis showed great convergence of the quantitative and qualitative findings. We propose seven recommendations for using the IHC resources in this setting. ConclusionsStudents and teachers from primary schools in Barcelona showed a positive experience when using IHC resources; however, these resources should be adapted to promote classroom participation

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers : An Overview of Systematic Reviews

Altres ajuts: This study is funded through a grant from Instituto de Salud Carlos III (PI18/00034), co-financed by funds from the European Regional Development Fund.Hepatobiliary cancers (that include hepatocellular carcinoma, intrahepatic or extrahepatic cholangiocarcinoma and gallbladder cancer) are usually treated with systemic oncological treatments (i.e., chemotherapy, immunotherapy and biological or targeted therapies) mainly due to their improvement in survival. However, the trade-off between these therapies and usual practice supportive care is not clear, and other outcomes beyond survival should be considered in advanced stages, such as quality of life or symptom control. The present study is part of a wider project aiming to conduct broad evidence syntheses assessing the effects of systemic oncological treatments versus usual practice supportive care for patients with advanced non-intestinal digestive cancers. We performed an overview of systematic reviews assessing the effects of systemic oncological treatments versus usual practice supportive care for patients with primary advanced hepatobiliary cancer. We found evidence that for these patients (specifically for advanced hepatocellular carcinoma), systemic oncological treatments tend to improve survival at the expense of greater toxicity. Much of systematic reviews included was of low quality and highly overlapped. Nevertheless, the evidence we found failed to report other important outcomes that could be critical for decision making, including quality of life or symptom control. Future research assessing these patient-important outcomes is needed. Background: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs. Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome. Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed. Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making