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

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.

Comparison of gemcitabine plus nab-paclitaxel and FOLFIRINOX in metastatic pancreatic cancer

“…In a recently published meta-analysis[ 9 ] and a systematic review article[ 12 ], these two chemotherapy regimens showed similar results. However, when analyzing these studies, the difference between Asian and Western patients may have affected their responses to chemotherapy.…”

Рак Поджелудочной Железы: Украинские И Мировые Тенденции

“…Індивідуалізація лікування зі збереженням максимально високого рівня життя останніми роками стала пріоритетним завданням науковців і зайняла важливе місце поряд із тривалістю життя онкопацієнтів. Кожного року з'являється все більше проспективних досліджень, ретроспективних системних оглядів, популяційних когортних досліджень, метааналізів, які підтверджують дані дослідження ACCORD 11 щодо показників загальної виживаності, тривалості безрецидивного періоду та профілю безпеки [9][10][11][12][13][14].…”

DPAGT1 Inhibitors of Capuramycin Analogues and Their Antimigratory Activities of Solid Tumors

“…43,44 Over the past years, the clinical data have not supported that FOLFIRINOX is associated with any better (or worse) survival rates compared to the nab-paclitaxel-gemcitabine regimen as there have been no head-to-head trials. 45 However, the inclusion of paclitaxel and its derivatives in combination regimens remains an important therapeutic strategy in pancreatic cancer chemotherapy since nab-paclitaxel-gemcitabine is associated with less adverse effects (toxicity in patients) than FOLFIRINOX. 46 In this regard, we were very interested in synergistic or additive effects of DPAGT1 inhibitor in combination with paclitaxel.…”