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

Nooraldin Merza; Sabeeh Khawar Farooqui; Sophia Haroon Dar; Tony Varughese; Rehmat Ullah Awan; Lamaan Qureshi; Saad Ali Ansari; Hadi Qureshi; Jamie Mcilvaine; Ishaan Vohra; Yusuf Nawras; Abdallah Kobeissy; Mona Hassan

doi:10.14740/wjon1604

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

World J Oncol. 2023 Oct;14(5):325-339. doi: 10.14740/wjon1604. Epub 2023 Sep 20.

Authors

Affiliations

¹ Department of Internal Medicine, University of Toledo, Toledo, OH, USA.
² Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.
³ Department of Internal Medicine, Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, USA.
⁴ Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
⁵ Department of Internal Medicine, Ochsner Rush Hospital, Meridian, MS, USA.
⁶ Edson College of Nursing and Health Innovations, Tempe, AZ, USA.
⁷ Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA.
⁸ School of Liberal Arts, Arizona State University, Maricopa, AZ, USA.
⁹ Department of OBGYN-Rutgers Jersey City, Jersey City, NJ, USA.
¹⁰ Gastroenterology Department, University of Illinois, Peoria, IL, USA.
¹¹ University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
¹² Department of Gastroenterology, University of Toledo, Toledo, OH, USA.

Abstract

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from inception till February 2023 to include all the relevant studies that compared FFX with GnP published and unpublished work.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.

Keywords: Folfirinox; Gemcitabine + nab-paclitaxel; Objective response rate; Overall survival; Pancreatic cancer; Progression-free survival.

Publication types

Review

Grants and funding

This study required no funding.