Abstract
BackgroundModified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NAB) have been recommended as first-line therapies for advanced pancreatic cancer (PC). Due to the lack of evidence to directly compare them, we conducted this network meta-analysis to indirectly compare the effectiveness and toxicity of modified FOLFIRINOX and GEM-NAB.MethodsThe eligible retrospective studies on treatments related to modified FOLFIRINOX and GEM-NAB up to 4 April 2020 were searched and assessed. We used the frequentist model to analyze the survival and toxicity data between different treatments. Pooled analysis for overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and events of toxicity were analyzed in this study.ResultsTwenty-two studies were involved in this network meta-analysis. The comparisons on OS and PFS showed that modified FOLFIRINOX and GEM-NAB had similar treatment efficacy (OS: 1.13; 95% CI: 0.78–1.63; PFS: HR: 1.19; 95% CI: 0.85–1.67). GEM-NAB was more effective than modified FOLFIRINOX based on the result of ORR (RR: 1.43; 95% CI: 1.04–1.96). Moreover, our analysis showed a similar toxicity profile between modified FOLFIRINOX and GEM-NAB.ConclusionsThe current evidence showed that modified FOLFIRINOX and GEM-NAB were similar in survival and toxicity. Many factors should be considered for in the formulation of optimal treatment, and our meta-analysis could provide some guidance to treatment selection in the first-line setting for advanced PC.
Highlights
Modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NAB) have been recommended as first-line therapies for advanced pancreatic cancer (PC)
Four kinds of treatment were analyzed in order to compare the efficacy and safety of modified FOLFIRINOX and GEM-NAB
For grade ≥ 3 adverse events, our analysis showed that the risk was higher in patients treated with modified FOLFIRINOX than GEM-NAB including neutropenia, febrile neutropenia, thrombocytopenia, anorexia, nausea and diarrhea
Summary
Modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NAB) have been recommended as first-line therapies for advanced pancreatic cancer (PC). Due to the lack of evidence to directly compare them, we conducted this network meta-analysis to indirectly compare the effectiveness and toxicity of modified FOLFIRINOX and GEM-NAB. As curative surgery could only be performed in less than 20% of cases, chemotherapy was commonly used in patients with locally advanced or metastatic PC. Chemotherapies based on gemcitabine or fluoropyrimidine are conventional in the treatments for advanced PC [2, 3]. Different anti-tumor agents were combined with gemcitabine or fluoropyrimidine in numerous clinical trials to improve treatment efficacy. Gemcitabine combined with nab-paclitaxel prolonged overall survival (OS) for around two months than gemcitabine monotherapy [4]
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