Levels of Evidence Supporting United States Guidelines in Pancreatic Adenocarcinoma Treatment

SIMPLE SUMMARY: The aim of our work is to describe the level of evidence supporting therapeutic recommendations in United States pancreatic adenocarcinoma guidelines, and its evolution over time. We recorded the level of evidence for each therapeutic recommendation extracted from the American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. In both United States guidelines, less than 9% of therapeutic recommendations are supported by a high level of evidence. In the National Comprehensive Cancer Network guidelines, there was no significant increase in high level of evidence recommendations over time. However, guidelines authors can only deal with the available evidence to develop recommendations while highlighting the strengths and weaknesses of included studies. There is a need for a more collaborative effort in pancreatic adenocarcinoma treatment to tackle important therapeutic questions and challenge the current framework of evidence. ABSTRACT: Cancer guidelines are ideally based on high levels of evidence (LOE). We aim to evaluate the LOE supporting recommendations in United States (US) guidelines on pancreatic adenocarcinoma (PDAC) treatment and its evolution over time. We searched for current guidelines from the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) and their prior publicly available versions on societies’ websites and/or MEDLINE. We recorded the LOE and class of recommendation (opinion of the writing panel) for each recommendation. We defined high LOE as: a “high” quality of evidence from the GRADE methodology (ASCO) and “Category 1” (NCCN). Our main outcome was the proportion of PDAC recommendations supported by high LOE. Proportions of high LOE recommendations were 5% (2/40) and 8% (12/153) in current ASCO and NCCN guidelines, respectively. Less than 10% of class I recommendations were based on high LOE. For NCCN guidelines, the proportion of high LOE recommendations did not improve over time and only three recommendations increased their LOE. We identified a small percentage of high LOE recommendations for PDAC treatment in US guidelines. However, guidelines authors can only deal with the available evidence. The current framework of evidence should be challenged with consideration of observational evidence.