Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 921-931
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.921
Clinical efficacy and safety of erlotinib combined with chemotherapy in the treatment of advanced pancreatic cancer: A meta-analysis
Xiao-Yan Liu, Hong-Nian Pan, Yue Yu
Xiao-Yan Liu, Yue Yu, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
Xiao-Yan Liu, Yue Yu, Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Xiao-Yan Liu, Hong-Nian Pan, Department of Gastroenterology, The Lu’an Hospital Affiliated to Anhui Medical University, The Lu’an People's Hospital, Lu’an 237000, Anhui Province, China
Co-corresponding authors: Hong-Nian Pan and Yue Yu
Author contributions: Liu XY and Pan HN acquired, analyzed, and interpreted the data; drafted, revised, and approved the manuscript; Yu Y conceived and designed the study, and critically revised and approved the final manuscript. Pan HN and Yu Y contributed efforts of equal substance throughout the research process; and the choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study.
Supported by National Natural Science Foundation of China, No. 31870993; Fundamental Research Funds for the Central Universities, No. WK9110000005; Anhui Provincial Health Research Project, No. AHWJ2022c020; Anhui Medical University Campus Level Research Fund, No. 2020xkj229; Lu'an City Science and Technology Plan Project, No. 2022Lakj009; and New Technology and Project of Lu'an People's Hospital, No. 2021xjs10.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue Yu, MD, PhD, Chief Physician, Professor, Cheeloo College of Medicine, Shandong University; Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 9 Lujiang Road, Hefei 230001, Anhui Province, China. yuyuemd@ustc.edu.cn
Received: December 19, 2023
Peer-review started: December 19, 2023
First decision: January 15, 2024
Revised: January 25, 2024
Accepted: February 7, 2024
Article in press: February 7, 2024
Published online: March 27, 2024
Processing time: 94 Days and 2 Hours
Abstract
BACKGROUND

Advanced pancreatic cancer is resistant to chemotherapeutic drugs, resulting in limited treatment efficacy and poor prognosis. Combined administration of the chemotherapeutic gemcitabine and erlotinib is considered a potential first-line treatment for advanced pancreatic cancer. However, their comparative benefits and potential risks remain unclear.

AIM

To assess the clinical efficacy and safety of erlotinib combined with other chemotherapy regimens for the treatment of advanced pancreatic cancer.

METHODS

Literature on the clinical efficacy and safety of erlotinib combined with chemotherapy for advanced pancreatic cancer was retrieved through an online search. The retrieved literature was subjected to a methodological qualitative assessment and was analyzed using the RevMan 5.3 software. Ten randomized controlled trials involving 2444 patients with advanced pancreatic cancer were included in the meta-analysis.

RESULTS

Compared with chemotherapeutic treatment, erlotinib combined with chemotherapy significantly prolonged the progression-free survival time of pancreatic cancer patients [hazard ratio (HR) = 0.78, 95%CI: 0.66–0.92, P = 0.003]. Meanwhile, the overall survival (HR= 0.99, 95%CI: 0.72–1.37, and P = 0.95) and disease control rate (OR = 0.93, 95%CI: 0.45–0.91, P = 0.84) were not significantly favorable. In terms of safety, the erlotinib and chemotherapy combination was associated with a significantly higher risk of diarrhea (OR = 3.59, 95%CI: 1.63–7.90, P < 0.05) and rash (OR = 3.63, 95%CI: 1.64–8.01, P < 0.05) compared with single-agent chemotherapy. Moreover, the risk of vomiting (OR = 1.27, 95%CI: 0.62–2.59, P = 0.51), regurgitation/anorexia (OR = 1.61, 95%CI: 0.25–10.31, P = 0.62), and infection (OR = 0.72, 95%CI: 0.28-1.87, P = 0.50) were not significant in either group.

CONCLUSION

Compared with a single chemotherapeutic modality, erlotinib combined with gemcitabine can prolong progression-free survival in pancreatic cancer, but does not improve survival benefit or disease control rate, and can increase the risk of diarrhea and rash.

Keywords: Erlotinib; Chemotherapy; Advanced pancreatic cancer; Efficacy; Safety; Meta-analysis

Core Tip: There is currently no consensus in the literature regarding which treatment (erlotinib combined with chemotherapy vs chemotherapy alone) is more beneficial among patients with pancreatic cancer. To the best of our knowledge, this is the first systematic review and meta-analysis to compare erlotinib and chemotherapy. We investigated the overall survival, disease control rate, progression-free survival, and safety of the two treatments.