Treatment with anticancer drugs for advanced pancreatic cancer: a systematic review
Josefina Salazar, Javier Bracchiglione, Olga Savall-Esteve, Alba Antequera, David Bottaro-Parra, Marta Gutiérrez‐Valencia, S. Martínez-Peralta, Carles Pericay, Ariadna Tibau, Xavier Bonfill, Roberto Acosta‐Dighero, Ariadna Auladell-Rispau, Yahveth Cantero‐Fortiz, Edgar Hernandez, Juan Ignacio Irassar, Adriana-Gabriela Meade, Pamela Meinardi, Ángela María Merchán-Galvis, Nicolás Meza, María Jesús Quintana, Carolina Requeijo, Gerardo Rodríguez-Grijalva, Karla Salas-Gama, Marilina Santero, Olga Savall-Esteve, Anna Selva, Iván Solà, Gerard Urrútia
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.