• Esther N Dekker, Raja R Narayan, Mohamed A Ahmami, Anis Meddouch, Eva M M Verkolf, Anne M Gehrels, BesselinkMarc G HMGH0000-0003-2650-9350Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands., van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Marjolein Y V Homs, Bianca Mostert, Grainne M O'Kane, Roeland F de Wilde, Johanna W Wilmink, Eileen M O'Reilly, Motaz Qadan, and Bas Groot Koerkamp.
• Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
• Br J Surg. 2024 Oct 1; 111 (10).

BackgroundPatients 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.MethodsA 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.ResultsA 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.ConclusionOne 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.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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