Systematic review on the safety and efficacy of immune checkpoint inhibitors combined with stereotactic body radiotherapy in advanced pancreatic cancer

This study aims to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in advanced pancreatic cancer (APC) patients, comparing SBRT alone to SBRT combined with immunotherapy. A systematic review was conducted following the PRISMA guidelines. Electronic databases, including Google Scholar, Medline, Embase, Cochrane, and PubMed, were searched up to October 23, 2024. Studies evaluating SBRT alone or in combination with immunotherapy for APC were included. Key outcomes assessed were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and grade 3/4 treatment-related adverse events (TRAEs). Data were analyzed and presented as percentages. The study is registered with PROSPERO under the registration number CRD420250655873. The 1-year OS rate was 44% for SBRT alone, compared to 8% for nivolumab + ipilimumab + SBRT, 80% for durvalumab + SBRT, and 2% for durvalumab + tremelimumab + SBRT. The 1-year PFS rate was 46% for SBRT alone, versus 43%, 4%, and 3% for the respective combinations. Grade 3/4 TRAEs were lower for SBRT alone (21.5%) compared to combination therapies: 79.1% for nivolumab + ipilimumab + SBRT, 73.2% for nivolumab + SBRT, 33.3% for durvalumab + SBRT, and 61.1% for durvalumab + tremelimumab + SBRT. SBRT is an effective treatment option for APC, with a 1-year OS rate of 44% and relatively low TRAEs. The combination of durvalumab + SBRT demonstrated a promising 1-year OS rate of 80%, highlighting its potential for further investigation.