P2231 - Comparative Efficacy and Safety of Chemotherapeutic, Targeted, and Immunotherapy Drugs for Pancreatic Ductal Adenocarcinoma Treatment: A Network Meta-Analysis of RCTs

Harshawardhan Dhanraj Ramteke, MBBS¹, Rakhshanda Khan, MBBS², Yashas Maragowdanahalli Somegowda, MBBS³, Ashesh Das, MBBS⁴, Hakim Wazir, MBBS⁵, Dineshbaba Murugavel, MD⁶, Karthik Sai Makineni, MBBS⁷, Rohit Mohanan Kumbalath, MD⁸, Aman Narula, MBBS⁹, Ramzia Muhammed Kunhi, MBBS¹⁰, Chirag Laxminarayana. Sagar, MBBS¹¹, Manognya Bellam, MBBS¹², Ashish Appani, MBBS¹³, Tanisha Suvarna, MBBS¹⁴, Ivin Thomas. Jolly, MBBBS¹, Insiya Mohammed. Rampurawala, ¹⁵, Shankar Biswas, MD¹⁶, Kapil Raut, DM, MD, MBBS¹⁷, Rachit Agrawal, MBBS, MD¹⁸
1Anhui Medical University, Hefei, Hefei, Anhui, China; 2Ayaan institute of medical sciences, Moinabad, Telangana, India; 3BGS Global Institute of Medical Sciences, Mysuru, Karnataka, India; 4KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 5Gajju Khan Medical College,Swabi Pakistan Medicine department, Shahmansor, Swabi, North-West Frontier, Pakistan; 6Tbilisi state university, Chennai, Tamil Nadu, India; 7SRM Medical College Hospital and Research Centre, Hyderabad, Telangana, India; 8Cebu Doctors’ University College of Medicine, Mumbai, Maharashtra, India; 9GMERS Medical College and Hospital, Vadodara, India, Vadodara, Gujarat, India; 10All India Institute of Medical Sciences Bhopal, Ajman, Ajman, United Arab Emirates; 11Kasturba Medical College, Mangaluru, Karnataka, India; 12SRM Medical College Hospital and Research Centre, San Diego, CA; 13Government Medical College and Hospital Nizamabad, Warangal, Telangana, India; 14JNMC Belgaum, Mumbai, Maharashtra, India; 15J.S.S. Medical College, Mysuru, Bengaluru, Karnataka, India; 16Ivano-Frankivsk National Medical University, Ukraine, Meerut, Uttar Pradesh, India; 17HCG cancer center, Nagpur, Maharashtra, India; 18saraswati kidney care center, Nagpur, Maharashtra, India

Introduction: Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive malignancy with a poor prognosis and limited treatment options. Current therapeutic strategies include chemotherapy, targeted therapies, and immunotherapy, but their comparative efficacy and safety remain uncertain.

Methods: A systematic search across five databases was conducted to identify relevant RCTs, with study screening performed using Covidence. The network meta-analysis was carried out using the Netmeta package in R, and forest plots and meta-analyses were generated with Stat 18.0. Risk of bias was assessed using the RoB 2.0 tool.

Results: Our analysis included 33 RCTs with a total sample size of 9,239 participants, comprising 5,636 in the treatment group and 3,603 in the control group. The included studies evaluated therapies such as Atezolizumab (79), Cabozantinib (76), Combined Chemotherapy (58), Demivistat + FOLFIRINOX (266), Durvalumab (3), EGPH20 + GEM-NABP (327), Erlotinib (518), FOLFIRINOX (433), Gemcitabine (2,090), Irinotecan (1,216), Mitazalimab (70), Nab-Paclitaxel (71), Nadunolimab (76), Napabucasin + GEM-NABP (565), Olaparib (124), Narilifox (766), Placebo (322), and Zenocutumab (454). The most significant survival benefit was observed with Irinotecan (OR = 4.96, 95% CI [1.45; 16.91],), while the least survival benefit was seen with Zenocutumab (OR = 0.38, 95% CI [0.03; 4.41],) compared to placebo. The SUCRA ranking analysis revealed that Zenocutumab ranked the lowest in terms of cumulative probability, indicating the worst performance, while Irinotecan and Cabozantinib exhibited the highest rankings, suggesting superior efficacy compared to other treatments. The risk ratios for adverse events, reflecting safety, were as follows: Neurological consequences 0.47 (95% CI -0.68 to 1.67), Nausea -0.31 (-0.82 to 0.20), HSR 0.28 (0.13 to 0.42), and Death 0.55 (-3.24 to 4.33). Quality of life was significantly improved in Irinotecan and Cabozantinib treatments. Additionally, the risk of bias was found to be low across all studies included in the analysis.

Discussion: The analysis identifies Irinotecan and Cabozantinib as promising PDAC treatments, demonstrating significant survival benefits and quality of life improvements. However, further studies are needed to validate these findings and evaluate long-term outcomes across diverse populations.


Figure: The brief overview of Network Meta-analysis for Pancreatic Ductal Adenocarcinoma Treatment

Disclosures:
Harshawardhan Dhanraj Ramteke indicated no relevant financial relationships.
Rakhshanda Khan indicated no relevant financial relationships.
Yashas Maragowdanahalli Somegowda indicated no relevant financial relationships.
Ashesh Das indicated no relevant financial relationships.
Hakim Wazir indicated no relevant financial relationships.
Dineshbaba Murugavel indicated no relevant financial relationships.
Karthik Sai Makineni indicated no relevant financial relationships.
Rohit Mohanan Kumbalath indicated no relevant financial relationships.
Aman Narula indicated no relevant financial relationships.
Ramzia Muhammed Kunhi indicated no relevant financial relationships.
Chirag Sagar indicated no relevant financial relationships.
Manognya Bellam indicated no relevant financial relationships.
Ashish Appani indicated no relevant financial relationships.
Tanisha Suvarna indicated no relevant financial relationships.
Ivin Jolly indicated no relevant financial relationships.
Insiya Rampurawala indicated no relevant financial relationships.
Shankar Biswas indicated no relevant financial relationships.
Kapil Raut indicated no relevant financial relationships.
Rachit Agrawal indicated no relevant financial relationships.

Harshawardhan Dhanraj Ramteke, MBBS¹, Rakhshanda Khan, MBBS², Yashas Maragowdanahalli Somegowda, MBBS³, Ashesh Das, MBBS⁴, Hakim Wazir, MBBS⁵, Dineshbaba Murugavel, MD⁶, Karthik Sai Makineni, MBBS⁷, Rohit Mohanan Kumbalath, MD⁸, Aman Narula, MBBS⁹, Ramzia Muhammed Kunhi, MBBS¹⁰, Chirag Laxminarayana. Sagar, MBBS¹¹, Manognya Bellam, MBBS¹², Ashish Appani, MBBS¹³, Tanisha Suvarna, MBBS¹⁴, Ivin Thomas. Jolly, MBBBS¹, Insiya Mohammed. Rampurawala, ¹⁵, Shankar Biswas, MD¹⁶, Kapil Raut, DM, MD, MBBS¹⁷, Rachit Agrawal, MBBS, MD¹⁸. P2231 - Comparative Efficacy and Safety of Chemotherapeutic, Targeted, and Immunotherapy Drugs for Pancreatic Ductal Adenocarcinoma Treatment: A Network Meta-Analysis of RCTs, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.