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Review
. 2019 May 19:11:1758835919850367.
doi: 10.1177/1758835919850367. eCollection 2019.

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

Elena Gabriela Chiorean  1 , Winson Y Cheung  2 , Guido Giordano  3 , George Kim  4 , Salah-Eddin Al-Batran  5
Affiliations
Review

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

Elena Gabriela Chiorean et al. Ther Adv Med Oncol. .

Erratum in

Abstract

Background: No clinical trial has directly compared nab-paclitaxel/gemcitabine (nab-P/G) with FOLFIRINOX (fluorouracil/leucovorin/oxaliplatin/irinotecan) in metastatic or advanced pancreatic cancer (mPC or aPC). We conducted a systematic review of real-world studies comparing these regimens in the first-line setting.

Methods: Embase and MEDLINE databases through 22 January 2019, and Gastrointestinal Cancers Symposium 2019 abstracts were searched for real-world, retrospective studies comparing first-line nab-P/G versus FOLFIRINOX in mPC or aPC that met specific parameters. Studies with radiotherapy were excluded. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: Of 818 records initially identified, 35 were duplicates and 749 did not meet the eligibility criteria, mostly because they were either not comparative (n = 356) or not first line (n = 245). The remaining 34 studies (21 mPC; 13 aPC) assessed >6915 patients who received nab-P/G or FOLFIRINOX. In the studies identified, the median overall survival (OS) reached 14.4 and 15.9 months with nab-P/G and FOLFIRINOX, respectively, and median progression-free survival reached 8.5 and 11.7 months, respectively. Safety data were reported in 14 studies (2205 patients), including 8 single-institutional studies. In most single-institutional studies that reported safety data, rates were higher with FOLFIRINOX versus nab-P/G for grade 3/4 neutropenia (five of six studies) and febrile neutropenia (all three studies), while rates of grade 3/4 peripheral neuropathy were higher with nab-P/G in four of seven studies.

Conclusions: Although FOLFIRINOX was associated with slightly longer median OS in more studies, the differences, when available, were not statistically significant. Therefore, a randomized, controlled trial is warranted. Toxicity profile differences represent key considerations for treatment decisions.

Keywords: FOLFIRINOX; nab-paclitaxel; pancreatic cancer; real-world evidence.

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Conflict of interest statement

Conflict of interest statement: EGC has served in an advisory role for Pfizer, Novocure, Genentech/Roche, Celgene, AstraZeneca, Eisai, Five Prime, Vicus, Halozyme, Seattle Genetics, Ipsen, and Array; she has received travel, accommodations, expenses from AstraZeneca; and her institution has received research funding from Celgene, Incyte, Stemline Therapeutics, Ignyta, Merck, Lilly, and Boehringer Ingelheim. WYC declares no conflict of interest. GG has received honoraria from Celgene and Sanofi; consulting or advisory role for Celgene; and he has received travel, accommodations, expenses from Celgene. GK has been a consultant and speaker for Celgene and Ipsen. SEAB has been in a consulting or advisory role for Merck, Roche, Celgene, Lilly, Bristol-Myers Squibb, and SERVIER; he has been on the speakers’ bureau for Lilly, Roche, Celgene, and Nordic Bioscience; he has received funding from Celgene, Roche Pharma AG, Lilly, Novartis, Vifor Pharma, Medac, and Hospira.

Figures

Figure 1.
Figure 1.
Study selection. aPC, advanced pancreatic cancer; FFX, FOLFIRINOX; mPC, metastatic pancreatic cancer; nab-P/G, nab-paclitaxel/gemcitabine. aStudies could be excluded for ⩾1 reason; once 1 reason was identified, no attempt was made to look for other potential reasons. bIncludes abstracts for which full manuscripts were subsequently published, encore presentations (most recent presentation included), or abstracts that were presented with updated data later. cThe symbol > indicates that some studies did not report the number of patients treated with nab-P/G or FFX and others evaluated additional treatment regimens. dThe symbol > indicates that some studies did not report the number of patients with mPC.
Figure 2.
Figure 2.
Overall survival in patients with advanced or metastatic pancreatic cancer receiving nab-P/G or FOLFIRINOX. mOS, median overall survival; n, number of studies reporting mOS; nab-P/G, nab-paclitaxel/gemcitabine.
See this image and copyright information in PMC

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