Irreversible electroporation combined with immunotherapy versus irreversible electroporation alone for locally advanced pancreatic cancer: a systematic review and meta-analysis.

OBJECTIVE

The aim of this meta-analysis was to determine the efficacy and safety of percutaneous irreversible electroporation combined with immunotherapy compared with irreversible electroporation alone in patients with locally advanced pancreatic cancer.

METHODS

We systematically searched Embase, Cochrane Central Register of Controlled Trials, and PubMed/Medline for relevant studies. The outcomes of interest were progression-free survival, overall survival, carbohydrate antigen 19-9 (CA 19-9) levels, and adverse events. Progression-free survival and overall survival were assessed using pooled hazard ratios (HR), odds ratios (OR) were used for adverse events, and mean differences (MD) for CA 19-9.

RESULTS

Four studies involving 310 patients were included in the pooled analysis. Irreversible electroporation combined with immunotherapy significantly prolonged progression-free survival compared with irreversible electroporation alone (hazard ratio [HR], 0.56; 95%CI=0.39 - 0.80; p<0.01; I2=10%). Additionally, patients who received irreversible electroporation plus immunotherapy achieved a greater overall survival compared with irreversible electroporation alone (HR=0.52; 95%CI=0.37 - 0.73; p<0.01; I2=0%). The pooled results for CA 19-9 showed significantly lower levels in patients receiving irreversible electroporation and immunotherapy compared with those receiving irreversible electroporation alone (MD: -70.18U/L; 95%CI=-121.07 - -19.29; p<0.01; I2=98%). No significant difference in the occurrence of adverse events such as nausea and vomiting (OR=1.58; 95%CI=0.71 - 3.49; p=0.26; I2=0%) and gastroparesis (OR=0.88; 95%CI=0.23 - 3.40; p=0.85; I2=0%) was not observed between the groups.

CONCLUSION

Combined therapy using percutaneous irreversible electroporation and systemic immunotherapy offers a safe and effective treatment approach for locally advanced pancreatic cancer, with irreversible electroporation potentially enhancing the efficacy of systemic immunotherapy in combined applications.

PROSPERO DATABASE REGISTRATION: ID CRD42024562216.