Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

Abstract

There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003;Banu et al, 2005;Liang, 2005;Bria et al, 2006;Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality therapy) vs best supportive care (ii) radiotherapy vs chemoradiation (iii) radiotherapy vs combined modality therapy (iv) chemotherapy vs combined modality therapy (v) 5FU-based combined modality treatment vs another-agent-based combined modality therapy. Relevant randomised controlled trials were identified by searching databases, trial registers and conference proceedings. The primary end point was overall survival and secondary end points were progression-free survival/time-to-progression, response rate and adverse events. Survival data were summarised using hazard ratio (HR) and response-rate/adverse-event data with relative risk. Eleven trials involving 794 patients met the inclusion criteria. Length of survival with chemoradiation was increased compared with radiotherapy alone (two trials, 168 patients, HR 0.69; 95% confidence interval (CI) 0.51 -0.94), but chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone (two trials, 134 patients, HR 0.79; CI 0.32 -1.95). Meta-analyses could not be performed for the other comparisons. A survival benefit was demonstrated for chemoradiation over radiotherapy alone. Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone, but important clinical differences cannot be ruled out due to the wide CI.

Evaluation of Prognostic Factors and Survival Results in Pancreatic Carcinomas in Turkey

“…In one study, while the median survival in patients who received only RT was 6 months, the survival in patients who underwent RT with 5FU chemotherapy increased to 10 months (Herreros-Villanueva et al, 2012). Sultana et al (2007) in their systematic review, which included a meta-analysis, showed that in locally advanced pancreatic cancer, CRT and survival increased only when compared with RT, and the risk of death was reduced by 32%. In this study, in patients who were operable and treated with CRT, the median survival was 12.5 months, while the 2-year survival was 34.4%.…”

Gemcitabine and capecitabine with or without telomerase peptide vaccine GV1001 in patients with locally advanced or metastatic pancreatic cancer (TeloVac): an open-label, randomised, phase 3 trial

“…The combination of gemcitabine with capecitabine was chosen as this could potentiate the vaccine effects and was also associated with significantly improved objective responses compared to gemcitabine alone. 22,37,38 Interpretation This is one of the largest randomized clinical trials ever undertaken in pancreatic cancer and the largest trial of vaccine therapy ever undertaken in any solid cancer type. There was no survival benefit from the addition of the GV1001 vaccine to gemcitabine and capecitabine in patients with advanced pancreatic cancer.…”

Combination of recombinant adenovirus-p53 with radiochemotherapy in unresectable pancreatic carcinoma

“…Previous randomized trials had shown that radiochemotherapy was superior to radiotherapy alone in treatment of locally advanced patients [5,6] . The treatment for patients with systemically advanced disease remains palliative and these 111111 patients should be offered an opportunity to take new available treatments [7] .…”