Clinical outcomes of immunotherapy in metastatic pancreatic carcinoma: A systematic review and meta-analysis.

Abstract

688 Background: Metastatic pancreatic carcinoma is one of the most challenging malignancies to treat. Traditional treatment modalities such as chemotherapy and radiation therapy have shown limited efficacy. This meta-analysis aims to investigate immunotherapy as a potential therapeutic option for metastatic pancreatic carcinoma. Methods: PubMed, Cochrane, Embase, and Clinicaltrials.gov were searched as per PRISMA guidelines. Data extraction was conducted independently by two reviewers, and any discrepancies were resolved through discussion. Pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.16-2). Results: 834 patients from the 17 studies reporting immunotherapy outcomes in metastatic pancreatic carcinoma were included in this systematic review and meta-analysis. The studies included (There were) were 4 phase I (23.5%), 2 phase Ib (11.8%), 1 phase Ib/II (5.9%), and 5 phase II (29.4%), 1 retrospective study (5.9%) and 4 prospective studies (23.5%). The median age of the patients was 61 years and 55.6% (398/716) were male. Immunotherapies included were GVAX, tremelimumab, Mesothelin-specific Chimeric Antigen Receptor T cells, durvalumab, pembrolizumab, canerpaturev, Sotigalimab, nivolumab, CO-1.01, allogeneic natural killer cell immunotherapy, Anti-EGFR chimeric antigen receptor-modified T cells, bispecific antibody armed T cells, and clivatuzumab tetraxetan. The median follow-up duration was 17.8 months. The median overall survival was 7.9 months, and the median progressive-free survival was 4.6 months. The pooled overall response rate was calculated at 16% (95% CI 0.09-0.26, I2=70, p<0.01, n= 426) and the pooled partial response rate was 13% (95% CI 0.09-0.26, I2= 67%, p<0.01, n= 272). The pooled stable disease was calculated to be 28% (95% CI, 0.2-0.39, I2= 59%, p<0.01, n=277). The pooled progressive disease was 36% (95% CI, 0.23-0.52, I2=34%, p=0.22, n=68). The most common overall adverse effects were anemia, diarrhea, and thrombocytopenia. Conclusions: This meta-analysis demonstrates that novel immunotherapies have promising results on metastatic pancreatic cancer. Future new clinical trials with a follow-up on current early-phase results are needed.