Merza Nooraldin, Farooqui Sabeeh Khawar, Dar Sophia Haroon, Varughese Tony, Awan Rehmat Ullah, Qureshi Lamaan, Ansari Saad Ali, Qureshi Hadi, Mcilvaine Jamie, Vohra Ishaan, Nawras Yusuf, Kobeissy Abdallah, Hassan Mona
Department of Internal Medicine, University of Toledo, Toledo, OH, USA.
Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.
World J Oncol. 2023 Oct;14(5):325-339. doi: 10.14740/wjon1604. Epub 2023 Sep 20.
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.
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from inception till February 2023 to include all the relevant studies that compared FFX with GnP published and unpublished work.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.
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).
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.
Folfirinox（FFX）或吉西他滨+纳米白蛋白结合型紫杉醇（GnP）作为胰腺癌（PC）一线用药的疗效和安全性尚未确定。我们进行了一项回顾性研究分析，通过比较这两种方案在PC患者中的生存和安全结果，来评估它们的疗效和安全性。
我们对两个电子数据库进行了全面检索，时间跨度从建库至2023年2月，纳入所有比较FFX与GnP的相关研究，包括已发表和未发表的作品。仅纳入回顾性研究。采用风险比（HRs）汇总总生存期（OS）和无进展生存期（PFS），采用随机效应模型，使用比值比（ORs）及95%置信区间（CI）汇总客观缓解率（ORR）和安全结果。
在入围的21篇文章中共确定了7030例患者。汇总结果表明，FFX和GnP均未显示能延长OS时间（HR：0.93，95%CI：0.83 - 1.04；P = 0.0001）；然而，与GnP相比，FFX更有可能延长PFS（HR：0.88，95%CI：0.81 - 0.97；P < 0.0001）。两种方案之间的ORR无显著差异（OR：0.90，95%CI：0.64 - 1.27；P = 0.15）。安全结果包括中性粒细胞减少、贫血、血小板减少和腹泻。GnP与腹泻的相关性更强（OR：1.96，95%CI：1.22 - 3.15；P = 0.001），而FFX在PC患者中更易导致贫血（OR：0.70，95%CI：0.51 - 0.98；P = 0.10）。两种药物方案中的中性粒细胞减少和血小板减少无显著差异（OR分别为1.10，95%CI：0.92 - 1.31；P = 0.33和OR：0.83，95%CI：0.60 - 1.13；P = 0.23）。
FFX和GnP在延长PFS方面存在显著差异，而在OS方面未观察到差异。安全结果显示，FFX和GnP具有相似的安全性，FFX与血液学结果相关，而GnP与非血液学结果相关性更强。
