BACKGROUND Patients with localized (that is non-metastatic) pancreatic ductal adenocarcinoma with an inadequate response or toxicity to first-line chemotherapy may benefit from chemotherapy switch. The aim was to explore the available data on the use and effect of chemotherapy switch, as reported in the literature. METHODS A systematic search was conducted in Embase, MEDLINE (Ovid), the Web of Science, Cochrane, and Google Scholar on 1 December 2023. The main outcomes were the proportion of patients who underwent chemotherapy switch and the carbohydrate antigen 19-9 response and resection, R0 resection, and ypN0 resection rates after chemotherapy switch. Data were pooled using a random-effects model. RESULTS A total of five retrospective studies, representing 863 patients with localized pancreatic ductal adenocarcinoma, were included and 226 of the 863 patients underwent chemotherapy switch. In four studies, first-line chemotherapy consisted of 5-fluorouracil/leucovorin/irinotecan with oxaliplatin ('FOLFIRINOX') and patients were switched to gemcitabine with nab-paclitaxel. Reasons for chemotherapy switch included an inadequate biochemical, clinical, or radiological response, or toxicity. Three studies compared patients who underwent chemotherapy switch with patients who only received first-line chemotherapy and found that the proportion of patients who underwent chemotherapy switch was 20.5% (95% c.i. 10.5% to 36.3%). The pooled resection rate after chemotherapy switch was 42.0% (95% c.i. 16.6% to 72.5%). Two studies compared the chance of resection after chemotherapy switch versus first-line chemotherapy alone and found a risk ratio of 0.88 (95% c.i. 0.65 to 1.18). Two studies, with a combined total of 576 patients, found similar postoperative survival for patients who underwent chemotherapy switch and patients who only received first-line chemotherapy. CONCLUSION One in five patients with localized pancreatic ductal adenocarcinoma underwent chemotherapy switch after an inadequate response or toxicity to first-line chemotherapy. The pooled resection rate after chemotherapy switch was 42% and similar in overall survival compared with first-line chemotherapy only. Three ongoing trials are investigating chemotherapy switch in patients with an inadequate radiological or carbohydrate antigen 19-9 response.

中文翻译：

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局限性胰腺癌的化疗转换：系统评价和荟萃分析。


背景 对一线化疗反应或毒性不足的局限性（即非转移性）胰腺导管腺癌患者可能受益于化疗转换。目的是探索文献中报道的有关化疗转换的使用和效果的现有数据。方法 2023 年 12 月 1 日在 Embase、MEDLINE （Ovid）、Web of Science 、Cochrane 和 Google Scholar 中进行了系统检索。主要结局是接受化疗转换的患者比例以及化疗转换后碳水化合物抗原 19-9 反应和切除、R0 切除和 ypN0 切除率。使用随机效应模型合并数据。结果 共纳入 5 项回顾性研究，涉及 863 例局限性胰腺导管腺癌患者，863 例患者中有 226 例接受了化疗转换。在四项研究中，一线化疗包括 5-氟尿嘧啶/亚叶酸/伊立替康联合奥沙利铂 （'FOLFIRINOX'），患者改用吉西他滨联合白蛋白结合型紫杉醇。化疗转换的原因包括生化、临床或放射学反应不足或毒性。三项研究将接受化疗转换的患者与仅接受一线化疗的患者进行了比较，发现接受化疗转换的患者比例为 20.5%（95% CI 为 10.5% 至 36.3%）。化疗转换后的合并切除率为 42.0% （95% ci. 16.6% 至 72.5%）。两项研究比较了化疗转换与单独一线化疗后切除的机会，发现风险比为 0.88 （95% CI 0.65 至 1.18）。 两项研究（共 576 名患者）发现，接受化疗转换的患者和仅接受一线化疗的患者术后生存率相似。结论 5 分之一的局限性胰腺导管腺癌患者在对一线化疗反应不足或毒性不足后接受了化疗转换。换化疗后的合并切除率为 42%，与仅一线化疗相比，总生存率相似。三项正在进行的试验正在研究放射学或碳水化合物抗原 19-9 反应不足的患者的化疗转换。