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.
Subject(s)
Antineoplastic Agents , Pancreatic Neoplasms , Humans , Quality of Life , Antineoplastic Agents/adverse effects , Pancreatic Neoplasms/drug therapy , Immunotherapy/methods , Pancreatic NeoplasmsABSTRACT
La quimioterapia neoadyuvante (QTN) es el tratamiento de elección en las pacientes con cáncer de mama localmente avanzado e inflamatorio. Los objetivos de este tratamiento son mejorar las opciones quirúrgicas (convertir tumores inoperables en operables, así como obtener mejores resultados estéticos), determinar la respuesta a la quimioterapia (respuesta patológica completa [pCR, en sus siglas en inglés]) y aumentar la supervivencia libre de enfermedad. La QTN es una situación clínica ideal para investigar predictores moleculares de respuesta, predecir los pacientes que conseguirán una pCR y los pacientes con un pronóstico favorable, aunque no alcancen una pCR. Los estudios actuales definirán mejor el esquema óptimo de quimioterapia (nuevos fármacos) y los pacientes que más se beneficiarán de este tratamiento(AU)
Neoadjuvant systemic therapy (NST) has become widely accepted as the treatment of choice for patients with locally advanced and inflammatory breast cancer. In general, NST is used to improve the surgical options (induction of tumour shrinkage that may render inoperable tumours amenable to surgery and may allow smaller resection and better cosmetic outcome for patients with operable tumours), to determine the response to NST (pCR: pathologic complete response), and to obtain long-term disease-free survival. NST is an ideal clinical setting to discover molecular predictors of response to therapy, to predict patients who will achieve a pCR, and patients who will have a favourable prognosis despite not achieving a pCR. Current trials will better define the optimal NST (new drugs) and those patients who might best benefit from this therapy(AU)
