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Review
. 2019 Apr 5;11(4):484.
doi: 10.3390/cancers11040484.

Comparative Effectiveness of Gemcitabine plus Nab-Paclitaxel and FOLFIRINOX in the First-Line Setting of Metastatic Pancreatic Cancer: A Systematic Review and Meta-Analysis

Sara Pusceddu  1 , Michele Ghidini  2 , Martina Torchio  3 , Francesca Corti  4 , Gianluca Tomasello  5 , Monica Niger  6 , Natalie Prinzi  7 , Federico Nichetti  8 , Andrea Coinu  9 , Maria Di Bartolomeo  10 , Mary Cabiddu  11 , Rodolfo Passalacqua  12 , Filippo de Braud  13   14 , Fausto Petrelli  15
Affiliations
Review

Comparative Effectiveness of Gemcitabine plus Nab-Paclitaxel and FOLFIRINOX in the First-Line Setting of Metastatic Pancreatic Cancer: A Systematic Review and Meta-Analysis

Sara Pusceddu et al. Cancers (Basel). .

Abstract

Gemcitabine and nab-paclitaxel (GEM-NAB) and the combination of 5-fluorouracil, oxaliplatin, and irinotecan (FOLFIRINOX) are valid first-line options for advanced or metastatic pancreatic cancer (mPC). However, no randomized trials comparing the two schemes have been performed. This meta-analysis aims to compare GEM-NAB and FOLFIRINOX in terms of safety and effectiveness, taking into account data from real-life studies on mPC. We systematically searched PubMed, EMBASE and Cochrane library up to November 2018 to identify retrospective or cohort studies on mPC comparing GEM-NAB and FOLFIRINOX. We included 16 retrospective studies, including 3813 patients (2123 treated with GEM-NAB and 1690 treated with FOLFIRINOX). Despite a median weighted overall survival (OS) difference in favor of FOLFIRINOX (mean difference: 1.15, 95% confidence interval CI 0.08⁻2.22, p = 0.03), in whole population OS was similar (hazard ratio (HR = 0.99, 95% CI 0.84⁻1.16; p = 0.9). PFS was also not different between the two arms (HR = 0.88, 95% CI 0.71⁻1.1; p = 0.26). The overall response rate was similar (25 vs. 24% with GEM-NAB and FOLFIRINOX). Among grade 3⁻4 toxicities, neutropenia, febrile neutropenia, and nausea were lower with GEM-NAB, while neurotoxicity and anemia were lower with FOLFIRINOX. In conclusion, despite a numerically longer median OS with FOLFIRINOX as compared to GEM-NAB, the overall risk of death and progression were similar. Their toxicity was different with less nausea, neutropenia, and febrile neutropenia with GEM-NAB, as compared to less neurotoxicity and anemia with FOLFIRINOX. Therefore, analysis of non-randomized "real world" studies to date has not provided evidence of a major benefit of one regimen over the other.

Keywords: FOLFIRINOX; and nab-paclitaxel; gemcitabine; pancreatic cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival comparison between gemcitabine plus nab paclitaxel and FOLFIRINOX. CI: confidence interval, GEM + NAB-P: gemcitabine plus nab paclitaxel, IV: interval variable, SE: standard error.
Figure 2
Figure 2
Progression-free survival comparison between gemcitabine plus nab paclitaxel and FOLFIRINOX. CI: confidence interval, GEM + NAB-P: gemcitabine plus nab paclitaxel, IV: interval variable, SE: standard error.
See this image and copyright information in PMC

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