Impact of first-line FOLFIRINOX versus Gemcitabine/Nab-Paclitaxel chemotherapy on survival in advanced pancreatic cancer: Evidence from the prospective international multicentre PURPLE pancreatic cancer registry

Santucci, Jordan; Tacey, Mark; Thomson, Benjamin; Michael, Michael; Wong, Rachel; Shapiro, Julia; Jennens, Ross; Clarke, Kerrie; Burge, Matthew; Zielinski, Rob; Nikfarjam, Mehrdad; Ananda, Sumitra; Lipton, Lara; Gibbs, Peter; Lee, Belinda

doi:10.1016/j.ejca.2022.06.042

Cited by 16 publications

(14 citation statements)

References 20 publications

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“…It is projected to become the second leading cause of cancer-related deaths by 2030. 18,19 Pancreatic surgery is considered one of the most complex abdominal surgeries with the highest rate of complications. The most common surgery-specific complications include postoperative pancreatic fistula, delayed gastric emptying, and postoperative hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Computed tomography and guidelines‐based human–machine fusion model for predicting resectability of the pancreatic cancer

Yimamu,

Li,

Zhang

et al. 2023

J of Gastro and Hepatol

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Background and AimThe study aims to develop a hybrid machine learning model for predicting resectability of the pancreatic cancer, which is based on computed tomography (CT) and National Comprehensive Cancer Network (NCCN) guidelines.MethodWe retrospectively studied 349 patients. One hundred seventy‐one cases from Center 1 and 92 cases from Center 2 were used as the primary training cohort, and 66 cases from Center 3 and 20 cases from Center 4 were used as the independent test dataset.Semi‐automatic module of ITK‐SNAP software was used to assist CT image segmentation to obtain three‐dimensional (3D) imaging region of interest (ROI). There were 788 handcrafted features extracted for 3D ROI using PyRadiomics. The optimal feature subset consists of three features screened by three feature selection methods as the input of the SVM to construct the conventional radiomics‐based predictive model (cRad). 3D ROI was used to unify the resolution by 3D spline interpolation method for constructing the 3D tumor imaging tensor. Using 3D tumor image tensor as input, 3D kernelled support tensor machine‐based predictive model (KSTM), and 3D ResNet‐based deep learning predictive model (ResNet) were constructed. Multi‐classifier fusion ML model is constructed by fusing cRad, KSTM, and ResNet using multi‐classifier fusion strategy. Two experts with more than 10 years of clinical experience were invited to reevaluate each patient based on their CECT following the NCCN guidelines to obtain resectable, unresectable, and borderline resectable diagnoses. The three results were converted into probability values of 0.25, 0.75, and 0.50, respectively, according to the traditional empirical method. Then it is used as an independent classifier and integrated with multi‐classifier fusion machine learning (ML) model to obtain the human–machine fusion ML model (HMfML).ResultsMulti‐classifier fusion ML model's area under receiver operating characteristic curve (AUC; 0.8610), predictive accuracy (ACC: 80.23%), sensitivity (SEN: 78.95%), and specificity (SPE: 80.60%) is better than cRad, KSTM, and ResNet‐based single‐classifier models and their two‐classifier fusion models. This means that three different models have mined complementary CECT feature expression from different perspectives and can be integrated through CFS‐ER, so that the fusion model has better performance. HMfML's AUC (0.8845), ACC (82.56%), SEN (84.21%), SPE (82.09%). This means that ML models might learn extra information from CECT that experts cannot distinguish, thus complementing expert experience and improving the performance of hybrid ML models.ConclusionHMfML can predict PC resectability with high accuracy.

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Section: Discussionmentioning

confidence: 99%

“…In the last 25 years, the incidence, prevalence, and mortality of PC have increased by 55%, 63%, and 53%, respectively. It is projected to become the second leading cause of cancer‐related deaths by 2030 18,19 . Pancreatic surgery is considered one of the most complex abdominal surgeries with the highest rate of complications.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography and guidelines‐based human–machine fusion model for predicting resectability of the pancreatic cancer

Yimamu,

Li,

Zhang

et al. 2023

J of Gastro and Hepatol

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“…The MPACT trial compared GEM monotherapy with GEM-NAB. Combination treatment prolonged OS to 8.5 months, compared to 6.7 months, with GEM monotherapy [16]. FOLFIRINOX is considered generally more toxic than the GEM-NAB combination and therefore, its use is limited to patients with a performance status and favorable comorbidity profiles.…”

Section: Molecular Background and Current Therapeutic Approachesmentioning

confidence: 99%

Nanomedicine and epigenetics: New alliances to increase the odds in pancreatic cancer survival

Urbanova

Cihova

Buociková

et al. 2023

Biomedicine & Pharmacotherapy

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“…A total of 18 studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] reported OS out of the 21 relevant studies. There was no statistical difference found in between the usage of FFX and GnP as first-line treatment to increase the OS time (HR: 0.93, 95% CI: 0.83 -1.04; P = 0.0001) (Fig.…”

Section: Osmentioning

confidence: 99%

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

Merza,

Farooqui,

Dar

et al. 2023

World J Oncol

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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.

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Impact of first-line FOLFIRINOX versus Gemcitabine/Nab-Paclitaxel chemotherapy on survival in advanced pancreatic cancer: Evidence from the prospective international multicentre PURPLE pancreatic cancer registry

Cited by 16 publications

References 20 publications

Computed tomography and guidelines‐based human–machine fusion model for predicting resectability of the pancreatic cancer

Computed tomography and guidelines‐based human–machine fusion model for predicting resectability of the pancreatic cancer

Nanomedicine and epigenetics: New alliances to increase the odds in pancreatic cancer survival

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

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