title: Systematic review and meta-analysis on targeted therapy in advanced pancreatic cancer.
abstract: OBJECTIVE
  A systematic review and meta-analysis from literature has been performed to assess the impact of targeted therapy in advanced pancreatic cancer.
  
  
  METHODS
  By searching different literature databases and major cancer meetings proceedings, data from all randomized clinical trials designed to investigate molecular targeted agents in the treatment of advanced pancreatic cancer were collected. The time-frame between January 2007 and March 2015 was selected. Data on predefined end-points, including overall survival, progression-free survival in terms of Hazard Ratio and response-rate were extracted and analyzed by a random effects model. Pooled data analysis was performed according to the DerSimonian and Laird test. The occurrence of publication bias was investigated through Begg's test by visual inspection of funnel plots.
  
  
  RESULTS
  Twenty-seven randomized clinical trials for a total of 8205 patients were selected and included in the final analysis. A significant benefit was demonstrated for anti-EGFR agents on overall survival (HR = 0.880; 95% confidence interval (CI) 0.797-0.972; p = 0.011). In the pooled analysis no benefit on overall survival (OS: pooled HR = 0.957; 95%CI 0.900-1.017; p = 0.153), or progression-free survival (PFS: pooled HR = 0.908; 95%CI 0.817-1.010; p = 0.075) for targeted-based therapies as compared to conventional treatments could be demonstrated. No advantage was reported in response-rate (OR for RR = 1.210; 95%CI 0.990-1.478; p = 0.063). Begg's funnel plot showed no evidence of publication bias.
  
  
  CONCLUSIONS
  The use of molecular targeted agents does not translate into clinical benefit. Therefore, our work highlights the need to identify predictive factors for patient selection and rationally designed clinical trials.
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy.
authors: Domenico
authors: D
authors: Ciliberto
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy.
authors: Nicoletta
authors: N
authors: Staropoli
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy.
authors: Silvia
authors: S
authors: Chiellino
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy.
authors: Cirino
authors: C
authors: Botta
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy.
authors: Pierfrancesco
authors: P
authors: Tassone
authors: Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, CampusSalvatore Venuta, Catanzaro 88100, Italy. Electronic address: tagliaferri@unicz.it.
authors: Pierosandro
authors: P
authors: Tagliaferri
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D020022:Genetic Predisposition to Disease; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000235:genetics; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents
keywords: Advanced pancreatic cancer; Meta-analysis; Pancreatic cancer; Pathway; Randomized clinical trials; Targeted therapy