Immune Checkpoint Inhibitors in PDAC Dashboard
SYSTEMATIC REVIEW AND META-ANALYSIS
Front. Oncol., 15 January 2025
Sec. Gastrointestinal Cancers
Volume 15 - 2025 | https://doi.org/10.3389/fonc.2025.1569884
Immune checkpoint inhibitors in pancreatic adenocarcinoma: a systematic review and meta-analysis of clinical outcomes
Aisha Al-Khinji, Noora Al-Korbi, Sara Al-Kuwari, Abdulla Al-Hor, Dhafer Malouche
Abstract
This systematic review and meta-analysis evaluates the efficacy of immune checkpoint inhibitors (ICIs) in pancreatic ductal adenocarcinoma (PDAC), analyzing 54 studies with 2,364 participants. We assessed objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) across ICI monotherapy, ICI combined with chemotherapy, and ICI combined with radiotherapy. Key findings reveal that ICI + chemotherapy significantly improves OS (HR 0.82, 95% CI: 0.78–0.87), while ICI + radiotherapy is associated with increased mortality risk (HR 1.18, 95% CI: 1.04–1.34). Biomarker-selected populations (high TMB, dMMR/MSI-H) show enhanced responses.
Key Findings
| Outcome | Treatment | Effect Size | 95% CI | Interpretation |
|---|---|---|---|---|
| OS | ICI + Chemotherapy | HR 0.82 | 0.78–0.87 | 18% mortality reduction |
| OS | ICI Monotherapy | HR 0.82 | 0.76–0.88 | Benefit in select patients |
| OS | ICI + Radiotherapy | HR 1.18 | 1.04–1.34 | ⚠️ Increased mortality |
| ORR | ICI + Chemotherapy | OR 1.78 | 1.46–2.16 | Improved response |
| PFS | All ICIs | HR 2.25 | 2.15–2.36 | Delayed progression |
Dashboard Features
- PRISMA Flow Diagram: Interactive visualization of study selection (545 → 54 studies)
- Risk of Bias Assessment: Traffic-light plots for RCTs and non-randomized studies
- Forest Plots: Interactive plots for ORR, OS, and PFS with filtering by treatment type
- Causal Bayesian Network: Model of treatment-biomarker-outcome relationships
- Subgroup Analysis: Exploration of high-TMB and dMMR patient outcomes
- Clinical Guidance: Evidence-based treatment recommendations
Subgroup Highlights
- High TMB Patients: Improved PFS with ICI therapy, better checkpoint blockade response
- MSI-H / dMMR Patients: ORR of 48.4%, median PFS of 26.7 months with durable responses
- APX005M + Chemotherapy: Highest ORR (67%) in triple combination regimens
Citation
Al-Khinji A, Al-Korbi N, Al-Kuwari S, Al-Hor A and Malouche D (2025) Immune checkpoint inhibitors in pancreatic adenocarcinoma: a systematic review and meta-analysis of clinical outcomes. Front. Oncol. 15:1569884. doi: 10.3389/fonc.2025.1569884
