Treatment with anticancer drugs for advanced pancreatic cancer: a systematic review

Abstract

Background Patients with advanced pancreatic cancer have a poor prognosis and high burden of cancer-related symptoms. It is necessary to assess the trade-off of clinical benefits and possible harms of treatments with anticancer drugs (TAD). This systematic review aims to compare the effectiveness of TAD versus supportive care or no treatment, considering all patient-important outcomes. Methods We searched PubMed, Embase, Cochrane Library, and Epistemonikos. Two reviewers performed selection, data extraction and risk of bias assessment. We assessed certainty of the evidence using the GRADE approach. Results We included 14 randomised controlled trials. Chemotherapy may result in a slight increase in overall survival (MD: 2.97 months (95%CI 1.23, 4.70)) and fewer hospital days (MD: -6.7 (-8.3, -5.1)), however, the evidence is very uncertain about its effect on symptoms, quality of life, functional status, and adverse events. Targeted/biological therapy may result in little to no difference in overall survival and a slight increment in progression-free survival (HR: 0.83 (95%CI 0.63, 1.10)), but probably results in more adverse events (RR: 5.54 (95%CI 1.24, 23.97)). The evidence is very uncertain about the effect of immunotherapy in overall survival and functional status. Conclusions The evidence is very uncertain about whether the benefits of using treatment with anticancer drugs outweigh their risks for patients with advanced pancreatic cancer. This uncertainty is further highlighted when considering immunotherapy or a second line of chemotherapy and thus, best supportive care would be an appropriate alternative. Future studies should assess their impact on all patient-important outcomes to inform patients in setting their goals of care.

Synergistic effect of additional anlotinib and immunotherapy as second‐line or later‐line treatment in pancreatic cancer: A retrospective cohort study

“…A subset of patients with PDAC who have progressed on standard first‐line chemotherapy still have a good performance status sufficient for second‐ or later‐line therapy. Currently, chemotherapy is generally recommended as a second‐line or later therapy for patients with PDAC, with median OS ranging from 2.3 to 6.1 months [ 23 , 24 ]. In this study, we compared additional anlotinib and anlotinib in combination with immunotherapy as only six patients received additional anlotinib alone.…”

“…second-line or later therapy for patients with PDAC, with median OS ranging from 2.3 to 6.1 months [23,24]. In this study, we compared additional anlotinib and anlotinib in combination with immunotherapy as only six patients received additional anlotinib alone.…”

Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review

“…However, the overall advantage is uncertain according to some researchers, who question if the benefits of palliative chemotherapy in PDAC patients outweigh their risks. This uncertainty is further highlighted when considering a second line of chemotherapy and, thus, BSC would be an appropriate alternative in these cases [70]. Current research is trying to identify the groups of PDAC patients who may benefit from subsequent lines of chemotherapy regimens [71].…”