Adjuvant therapy for resectable pancreatic cancer
Evidence Summaries Level of Evidence = B
Adjuvant chemotherapy appears to prolong survival in patients with resectable pancreatic cancer.
A systematic review 1 including 4 studies with a total of 875 subjects was abstracted in DARE. Individual patient data was analyzed. Chemotherapy significantly reduced the risk of death compared with no chemotherapy (HR 0.75, 95% CI: 0.64 to 0.90, P=0.001). After removing one RCT with an unusually high proportion of patients with positive resection margins, significant heterogeneity was no longer present (P=0.29) and the reduction in risk of death with chemotherapy was still statistically significant (HR 0.65, 95% CI: 0.54 to 0.80, P<0.001). Median survival was 19 months with chemotherapy and 13.5 months without. The 2- and 5- year survival rates were 38% and 19%, respectively, with chemotherapy and 28% and 12% without. There was no difference in the risk of death with chemoradiation compared with no chemoradiation (HR 1.09, 95% CI: 0.89 to 1.32, P=0.43). Median survival was 15.8 months with chemoradiation and 15.2 months without.
Comment: The quality of evidence is downgraded by poor reporting of review methodology.
1. Stocken DD, Büchler MW, Dervenis C, Bassi C, Jeekel H, Klinkenbijl JH, Bakkevold KE, Takada T, Amano H, Neoptolemos JP, Pancreatic Cancer Meta-analysis Group. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005 Apr 25;92(8):1372-81. [PMID:15812554]
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