Chemotherapy switch for localized pancreatic cancer: a systematic review and meta-analysis.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2024-10-01 DOI:10.1093/bjs/znae244

Esther N Dekker,Raja R Narayan,Mohamed A Ahmami,Anis Meddouch,Eva M M Verkolf,Anne M Gehrels,Marc G H Besselink,Casper H J van Eijck,Marjolein Y V Homs,Bianca Mostert,Grainne M O'Kane,Roeland F de Wilde,Johanna W Wilmink,Eileen M O'Reilly,Motaz Qadan,Bas Groot Koerkamp

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引用次数: 0

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.

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局部胰腺癌化疗转换：系统综述和荟萃分析。

背景对一线化疗反应不佳或毒性不足的局部（即非转移性）胰腺导管腺癌患者可能会从化疗转换中获益。方法2023年12月1日在Embase、MEDLINE (Ovid)、Web of Science、Cochrane和谷歌学术中进行了系统检索。主要结果为接受化疗转换的患者比例以及化疗转换后碳水化合物抗原19-9的反应和切除率、R0切除率以及ypN0切除率。结果共纳入了五项回顾性研究，代表了863例局部胰腺导管腺癌患者，863例患者中有226例接受了化疗转换。在四项研究中，一线化疗包括5-氟尿嘧啶/亮紫杉烷/伊立替康加奥沙利铂（"FOLFIRINOX"），然后患者改用吉西他滨加纳布-紫杉醇。化疗转换的原因包括生化、临床或放射学反应不充分或毒性。三项研究将接受化疗转换的患者与只接受一线化疗的患者进行了比较，发现接受化疗转换的患者比例为20.5%（95% c.i.10.5%至36.3%）。化疗转换后的总切除率为 42.0%（95% 置信区间：16.6% 至 72.5%）。两项研究比较了化疗转换后切除的几率与单纯一线化疗的几率，发现两者的风险比为0.88（95% c.i.0.65至1.18）。结论每五名局部胰腺导管腺癌患者中就有一人在对一线化疗反应不佳或出现毒性反应后接受了化疗转换。化疗转换后的总切除率为42%，总生存期与仅接受一线化疗的患者相似。目前有三项试验正在研究对放射学反应或碳水化合物抗原19-9反应不充分的患者进行化疗转换。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.