About 80%-85% of patients with pancreatic cancer are unresectable at first diagnosis. Several studies have examined nab-paclitaxel plus gemcitabine (NG) in patients with locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC). The objective of this analysis was to evaluate the effectiveness of NG as first-line treatment in this specific patient population.
We searched Pubmed for eligible studies from the day of inception to April 15th, 2018 for studies of chemo(radiation)therapy-naïve patients who accepted NG as first-line treatment of unresectable pancreatic cancer (UPC). Overall objective response rate (ORR), 1-year overall survival (OS) and 6-month progression free survival (PFS) rates were estimated by randomized-effect model. Subgroup analyses were conducted in LAPC and MPC.
Of 890 patients included from 16 studies, 53 patients were LAPC and 837 patients were MPC. Median OS from the start of NG of all patients ranged from 8.7 months to 20.0 months with a 1-year survival rate of 50.9% (95%CI 40.1% to 61.8%). Median PFS ranged from 2.2 months to 8.4 months with a 6-month PFS rate of 52.8% (95%CI 33.2% to 72.3%). In single arm analysis, the overall ORR in unresectable pancreatic cancer was 34.4% (95%CI 25.3% to 43.5%). In patients with LAPC, 90.6% (48/53) underwent surgery and the R0 resection rate was 81.2% (ranging from 70% to 100%), achieving a 1-year survival rate of 97.5%. In patients with MPC, the ORR was 30.8% and the 1-year survival rate was 44.6%. Five hundred and fifty six grade 3/4 adverse events and no death caused by toxicity were reported in 15 studies consisting of 871 patients.
This is the first meta-analysis to evaluate the effectiveness of NG for UPC. More than 50% of patients with UPC treated with NG survived longer than 12 months. NG showed favorable tumor reducing effect with acceptable toxicity profile. Randomized controlled trials are needed to confirm the efficacy of NG in patients with LAPC.
Clinical trial identification
Legal entity responsible for the study
National Science Fund for Distinguished Young Scholars (81625016).
All authors have declared no conflicts of interest.