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. 2021 Jul 23;21(1):853.
doi: 10.1186/s12885-021-08605-x.

Meta-analysis and indirect treatment comparison of modified FOLFIRINOX and gemcitabine plus nab-paclitaxel as first-line chemotherapy in advanced pancreatic cancer

Jiayuan Chen  1 , Qingling Hua  1 , Haihong Wang  1 , Dejun Zhang  1 , Lei Zhao  1 , Dandan Yu  1 , Guoliang Pi  2 , Tao Zhang  3 , Zhenyu Lin  4
Affiliations

Meta-analysis and indirect treatment comparison of modified FOLFIRINOX and gemcitabine plus nab-paclitaxel as first-line chemotherapy in advanced pancreatic cancer

Jiayuan Chen et al. BMC Cancer. .

Abstract

Background: 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.

Methods: The 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.

Results: Twenty-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.

Conclusions: The 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.

Keywords: Gemcitabine; Modified FOLFIRINOX; Nab-paclitaxel; Network meta-analysis; Pancreatic cancer; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for study search (PRISMA diagram)
Fig. 2
Fig. 2
Indirect comparisons of toxicities: modified FOLFIRINOX vs. GEM-NAB. Data presented as odds ratio (OR) with 95% confidence interval (CI); the 95% confidence interval that did not contain the value of 1 represents as statistical significance. Statistically significant comparisons of toxicities between other treatments were also demonstrated
See this image and copyright information in PMC

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