Systematic review and meta-analysis on safety and efficacy of immune checkpoint inhibitors and radiotherapy for advanced pancreatic cancer

Objective: The aim of this study is to assess the safety and efficacy of stereotactic body radiotherapy (SBRT) in combination with immune checkpoint inhibitors (ICIs) in patients with advanced pancreatic cancer. Method: A PRISMA selection protocol was used to identify studies across electronic databases such as; PubMed, Google scholar, Cochrane, Embase, and web of science from inception until November 23, 2022, where data from SBRT studies were compared to data from a combination of SBRT and ICIs for advanced pancreatic cancer. The endpoints recorded after therapy were overall survival (OS), complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), progression-free survival (PFS) and treatment-related adverse effect (TRAE) were collected in each study. Results: The primary endpoint (OS) retrieved from five studies following SBRT disclosed OS at the rate of one year at 44% as compared to the combination studies of SBRT+ICI with 42%. PFS recorded at the rate of 1 year revealed an outcome of 46% following SBRT. In contrast, PFS in the combination studies recorded SBRT+ICI of 86%. The risk of grade >3 TRAE in the SBRT was 21.5% as compared to the combination studies of 75%. This risk of grade>3 TRAE was reduced as compared to any grade in two studies (Heterogeneity: Chi² = 2.78, df = 1 (P = 0.10); I² = 64%). Conclusion: The Combination of SBRT and ICIs demonstrate modest treatment efficiency and acceptable safety profile in patients with advanced pancreatic cancer. However, combination trials are fewer, and further studies are warranted.