Systematic review of novel ablative methods in locally advanced pancreatic cancer

Table 2 Endoscopic ultrasound administered non-ablative anti-tumour therapies for pancreatic ductal adenocarcinoma

Author	Therapy	Patients	n	Outcome and survival	Complications
Chang et al[77]	Cytoimplant (mixed lymphocyte culture)	Unresectable PDAC	8	Median survival: 13.2 mo. 2 partial responders and 1 minor response	7/8 developed low-grade fever 3/8 required biliary stent placement
Hecht et al[78]	ONYX-015 (55-kDa gene-deleted adenovirus) + IV gemcitabine	Unresectable PDAC	21	No patient showed tumour regression at day 35. After commencement of gemcitabine, 2/15 had a partial response	Sepsis: 2/15 Duodenal perforation: 2/15
Hecht et al[79] Chang et al[80,81]	TNFerade (replication-deficient adenovector containing human tumour necrosis factor (TNF)-α gene)	Locally advanced PDAC	50	Response: One complete response, 3 partial responses. Seven patients eventually went to surgery, 6 had clear margins and 3 survived > 24 mo	Dose-limiting toxicities of pancreatitis and cholangitis were observed in 3/50
Herman et al[82]	Phase III study of standard care plus TNFerade (SOC + TNFerade) vs standard care alone (SOC)	Locally advanced PDAC	304 (187 SOC + TNFerade)	Median survival: 10.0 mo for patients in both the SOC + TNFerade and SOC arms [hazard ratio (HR), 0.90, 95%CI: 0.66-1.22, P = 0.26]	No major complications. Patients in the SOC + TNFerade arm experienced more grade 1 to 2 fever than those in the SOC alone arm (P < 0.001)
Sun et al[83]	EUS-guided implantation of radioactive seeds (iodine-125)	Unresectable PDAC	15	Tumour response: "partial" in 27% and "minimal" in 20%. Pain relief: 30%	Local complications (pancreatitis and pseudocyst formation) 3/15. Grade III hematologic toxicity in 3/15
Jin et al[84]	EUS-guided implantation of radioactive seeds (iodine-125)	Unresectable PDAC	22	Tumour response: “partial” in 3/22 (13.6%)	No complications

PDAC: Pancreatic ductal adenocarcinoma; EUS: Endoscopic ultrasound.