Abstract
Guidelines for treatment of metastatic pancreatic cancer recommend a second line based on Fluoropyrimidine (FP) alone or in combination with Oxaliplatin (OXA) or Irinotecan (IRI) after a first line treatment based on Gemcitabine (GEM). We conducted a Bayesian network meta-analysis to compare currently available therapies to treat metastatic pancreatic cancer in the second line, considering as efficacy measures overall survival (OS) and progression free survival (PFS). Published randomized trials were identified using electronic databases (MEDLINE, PubMed, https://clinicaltrials.gov/ and American Society of clinical oncology). 8 studies met the inclusion criteria for a total of 1,587 patients and 7 different therapeutic schemes. The results suggested that the use of IRI-FP-Folinic Acid scheme in the second-line treatment of metastatic pancreatic cancer may offer a benefit in terms of OS and PFS for patients not previously treated with these drugs.
Highlights
Pancreatic cancer still has a poor prognosis, and progress in the treatment of this disease is poor
The results suggested that the use of IRI-FP-Folinic Acid scheme in the second-line treatment of metastatic pancreatic cancer may offer a benefit in terms of Overall Survival (OS) and Progression Free Survival (PFS) for patients not previously treated with these drugs
The second line chemotherapy drugs studied in various combinations were IRI, FP, folinic acid (FA) and OXA
Summary
Pancreatic cancer still has a poor prognosis, and progress in the treatment of this disease is poor. Standard first-line therapies are combinations of Gemcitabine (GEM) based chemotherapy, such as GEM plus Nab-paclitaxel or, for the best performing patients, the FOLFIRINOX regimen containing 5-fluorouracil (5FU), Oxaliplatin (OXA), Irinotecan (IRI) and folinic acid (FA) The choice between these two regimens poses a challenging problem: for patients candidate to receive a second-line chemotherapy, the selection depends in part on their previous treatment. There are no randomized trials conducted on a large number of patients indicating which of the proposed therapies are the best from the point of view of efficacy The aim of this project was to compare, through a Bayesian network meta-analysis of published randomized clinical trials, the currently available therapies to treat metastatic pancreatic cancer in the second line, after a first line treatment based on GEM/GEM combination. We focused on both Overall Survival (OS), and Progression Free Survival (PFS)
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