Anticancer Drugs Compared to No Anticancer Drugs in Patients with Advanced Hepatobiliary Cancer: A Mapping Review and Evidence Gap Map

Abstract

Introduction

Despite being commonly recommended, the impact of anticancer drugs (ACDs) on patient-important outcomes beyond survival for advanced hepatobiliary cancers (HBCs) may not have been sufficiently assessed. We aim to identify and map the evidence regarding ACDs versus best supportive care (BSC) for advanced HBCs, considering patient-centered outcomes.

Methods

In this mapping review, we included systematic reviews, randomized controlled trials, quasi-experimental, and observational studies comparing ACDs (chemotherapy, immunotherapy, biological/targeted therapy) versus BSC for advanced HBCs. We searched MEDLINE (PubMed), EMBASE (Ovid), Cochrane Library, Epistemonikos, PROSPERO and clinicaltrials.gov for eligible studies. Two reviewers performed the screening and data extraction processes. We developed evidence maps for each type of cancer.

Results

We included 87 studies (60 for advanced liver cancer and 27 for gallbladder or bile duct cancers). Most of the evidence favored ACDs for survival outcomes, and BSC for toxicity. We identified several evidence gaps for non-survival outcomes, including quality of life or quality of end-of-life care.

Discussion

Patient-important outcomes beyond survival in advanced HBCs are insufficiently assessed by the available evidence. Future studies need to address these gaps to better inform decision-making processes.

Keywords:

• liver neoplasms
• gallbladder neoplasms
• bile duct neoplasms
• antineoplastic agents
• immunotherapy
• biological therapy
• palliative care

Acknowledgments

Carolina Requeijo is a doctoral candidate for the Ph.D. in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.

We would like to thank Yang Song for her help in translating and extracting one of the included reviews, and Juan Carlos Vázquez for his help in the full-text screening process.

Members of ASTAC-Study Research Group: Acosta-Dighero R, Antequera A, Auladell-Rispau A, Bonfill X, Bracchiglione J, Cantero-Fortiz Y, Dorantes R, Hernández ED, Irassar J, Meade AG, Meinardi P, Merchán-Galvis AM, Meza N, Quintana MJ, Requeijo C, Rodríguez-Grijalva G, Salas-Gama K, Salazar J, Santero M, Savall-Esteve O, Selva A, Simancas D, Solà I, Urrútia G.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study has been funded by Instituto de Salud Carlos III through the project “PI18/00034” (Co-funded by European Regional Development Fund “A way to make Europe”).