Folfirinox vs. Gemcitabine + Nab-Paclitaxel as the First-Line Treatment for Pancreatic Cancer: A Systematic Review and Meta-Analysis.

Autor:	Merza N; Department of Internal Medicine, University of Toledo, Toledo, OH, USA., Farooqui SK; Department of Medicine, Ziauddin Medical University, Karachi, Pakistan., Dar SH; Department of Internal Medicine, Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, USA., Varughese T; Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA., Awan RU; Department of Internal Medicine, Ochsner Rush Hospital, Meridian, MS, USA., Qureshi L; Edson College of Nursing and Health Innovations, Tempe, AZ, USA., Ansari SA; Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA., Qureshi H; School of Liberal Arts, Arizona State University, Maricopa, AZ, USA., Mcilvaine J; Department of OBGYN-Rutgers Jersey City, Jersey City, NJ, USA., Vohra I; Gastroenterology Department, University of Illinois, Peoria, IL, USA., Nawras Y; University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA., Kobeissy A; Department of Gastroenterology, University of Toledo, Toledo, OH, USA., Hassan M; Department of Gastroenterology, University of Toledo, Toledo, OH, USA.
Jazyk:	angličtina
Zdroj:	World journal of oncology [World J Oncol] 2023 Oct; Vol. 14 (5), pp. 325-339. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.14740/wjon1604
Abstrakt:	Background: The efficacy and safety of Folfirinox (FFX) or gemcitabine + nab-paclitaxel (GnP) to be used as the first-line drugs for pancreatic cancer (PC) is yet to be established. We conducted an analysis of retrospective studies to assess the efficacy and safety of these two regimens by comparing their survival and safety outcomes in patients with PC. Methods: We conducted an extensive review of two electronic databases from inception till February 2023 to include all the relevant studies that compared FFX with GnP published and unpublished work. Retrospective studies were only included. Overall survival (OS) and progression-free survival (PFS) were pooled using hazard ratios (HRs), while objective response rate (ORR) and safety outcomes were pooled using odds ratios (ORs) with 95% confidence interval (CI) using the random effects model. Results: A total of 7,030 patients were identified in a total of 21 articles that were shortlisted. Pooled results concluded that neither FFX nor GnP was associated to increase the OS time (HR: 0.93, 95% CI: 0.83 - 1.04; P = 0.0001); however, FFX was more likely associated with increased PFS when compared to GnP (HR: 0.88, 95% CI: 0.81 - 0.97; P < 0.0001). ORR proved to be non-significant between the two regimens (OR: 0.90, 95% CI: 0.64 - 1.27; P = 0.15). Safety outcomes included neutropenia, anemia, thrombocytopenia and diarrhea. GnP was more associated with diarrhea (OR: 1.96, 95% CI: 1.22 - 3.15; P = 0.001), while FFX was seen to cause anemia (OR: 0.70, 95% CI: 0.51 - 0.98; P = 0.10) in PC patients. Neutropenia and thrombocytopenia were in-significant in the two drug regimens (OR: 1.10, 95% CI: 0.92 - 1.31; P = 0.33 and OR: 0.83, 95% CI: 0.60 - 1.13; P = 0.23, respectively). Conclusion: FFX and GnP showed a significant difference in increasing the PFS, while no difference was observed while measuring OS. Safety outcomes showed that FFX and GnP shared similar safety profiles as FFX was associated with hematological outcomes, while GnP was more associated with non-hematological outcomes. Competing Interests: The authors declare that they have no conflict of interest. (Copyright 2023, Merza et al.)
Databáze:	MEDLINE
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