Chemotherapy switch for localized pancreatic cancer: A systematic review and meta-analysis Review


Authors: Dekker, E. N.; Narayan, R. R.; Ahmami, M. A.; Meddouch, A.; Verkolf, E. M. M.; Gehrels, A. M.; Besselink, M. G. H.; van Eijck, C. H. J.; Homs, M. Y. V.; Mostert, B.; O'Kane, G. M.; de Wilde, R. F.; Wilmink, J. W.; O'Reilly, E. M.; Qadan, M.; Groot Koerkamp, B.
Review Title: Chemotherapy switch for localized pancreatic cancer: A systematic review and meta-analysis
Abstract: Background: Patients with localized (that is non-metastatic) pancreatic ductal adenocarcinoma with an inadequate response or toxicity to first-line chemotherapy may benefit from chemotherapy switch. The aim was to explore the available data on the use and effect of chemotherapy switch, as reported in the literature. Methods: A systematic search was conducted in Embase, MEDLINE (Ovid), the Web of Science, Cochrane, and Google Scholar on 1 December 2023. The main outcomes were the proportion of patients who underwent chemotherapy switch and the carbohydrate antigen 19-9 response and resection, R0 resection, and ypN0 resection rates after chemotherapy switch. Data were pooled using a random-effects model. Results: A total of five retrospective studies, representing 863 patients with localized pancreatic ductal adenocarcinoma, were included and 226 of the 863 patients underwent chemotherapy switch. In four studies, first-line chemotherapy consisted of 5-fluorouracil/leucovorin/irinotecan with oxaliplatin ('FOLFIRINOX') and patients were switched to gemcitabine with nab-paclitaxel. Reasons for chemotherapy switch included an inadequate biochemical, clinical, or radiological response, or toxicity. Three studies compared patients who underwent chemotherapy switch with patients who only received first-line chemotherapy and found that the proportion of patients who underwent chemotherapy switch was 20.5% (95% c.i. 10.5% to 36.3%). The pooled resection rate after chemotherapy switch was 42.0% (95% c.i. 16.6% to 72.5%). Two studies compared the chance of resection after chemotherapy switch versus first-line chemotherapy alone and found a risk ratio of 0.88 (95% c.i. 0.65 to 1.18). Two studies, with a combined total of 576 patients, found similar postoperative survival for patients who underwent chemotherapy switch and patients who only received first-line chemotherapy. Conclusion: One in five patients with localized pancreatic ductal adenocarcinoma underwent chemotherapy switch after an inadequate response or toxicity to first-line chemotherapy. The pooled resection rate after chemotherapy switch was 42% and similar in overall survival compared with first-line chemotherapy only. Three ongoing trials are investigating chemotherapy switch in patients with an inadequate radiological or carbohydrate antigen 19-9 response. © 2024 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.
Keywords: mortality; fluorouracil; gemcitabine; pancreatic neoplasms; antineoplastic agent; antineoplastic combined chemotherapy protocols; carcinoma, pancreatic ductal; pathology; folinic acid; pancreas tumor; surgery; drug therapy; drug substitution; oxaliplatin; deoxycytidine; leucovorin; meta analysis; pancreatic ductal carcinoma; humans; human; doxecitine
Journal Title: British Journal of Surgery
Volume: 111
Issue: 10
ISSN: 0007-1323
Publisher: Oxford University Press  
Date Published: 2024-10-01
Start Page: znae244
Language: English
DOI: 10.1093/bjs/znae244
PUBMED: 39400008
PROVIDER: scopus
PMCID: PMC11472162
DOI/URL:
Notes: Review -- Source: Scopus
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  1. Eileen O'Reilly
    783 O'Reilly