Objectives: FOLFIRINOX, gemcitabine/nab-paclitaxel (gem-nab/P), and gemcitabine-capecitabine (gem-cap) demonstrated superiority over gemcitabine monotherapy for pancreatic cancer (PC). It is still unclear which chemotherapy regimen is the most optimal. This study aimed to conduct a systematic review (SR) and indirect comparison to compare safety and efficacy of FOLFIRINOX versus gem-nab/P and gem-cap in PC. Methods: An SR was conducted in several databases from inception to November 2020. RCTs investigating resectable or advanced PC were included. Primary outcomes including overall survival (OS), disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS), and grade 3/4 adverse events (AEs) were pooled using a random effects model. Indirect comparisons were done to compare FOLFIRINOX versus gem-cap and gem-nab/P. Heterogeneity was evaluated using Cochran’s Q test and I² statistics. Results: Nine studies were identified involving 6,564 patients. Indirect comparisons showed FOLFIRINOX had significantly better OS (resectable: HR 0.78 [0.61–0.99]; advanced: HR 0.71 [0.60–0.85]) and RFS/DFS/PFS (resectable: HR 0.67 [0.55–0.82]; advanced: HR 0.65 [0.57–0.74]) compared to gem-cap as well as OS (resectable: HR 0.78 [0.61–1.00]; advanced: HR 0.73 [0.54–0.98]) and DFS/PFS (resectable: HR 0.66 [0.53–0.82]; advanced: HR 0.64 [0.49–0.83]) compared to gem-nab/P. FOLFIRINOX increased grade 3/4 AE risk compared to gem-cap and gem-nab/P. Conclusions: FOLFIRINOX is associated with significant survival benefits compared to gem-nab/P and gem-cap. However, it is important to consider the increased grade 3/4 AE risk associated with FOLFIRINOX.
Oncol Res Treat

中文翻译：

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可切除和晚期/转移性胰腺癌治疗方案的比较安全性和有效性：系统评价和间接比较

目标： FOLFIRINOX、吉西他滨/白蛋白结合型紫杉醇 (gem-nab/P) 和吉西他滨 - 卡培他滨 (gem-cap) 在治疗胰腺癌 (PC) 上表现出优于吉西他滨单药治疗的效果。目前尚不清楚哪种化疗方案是最佳的。本研究旨在进行系统评价 (SR) 和间接比较，以比较 FOLFIRINOX 与 gem-nab/P 和 gem-cap 在 PC 中的安全性和有效性。方法：从开始到 2020 年 11 月，在多个数据库中进行了 SR。包括研究可切除或晚期 PC 的 RCT。主要结局包括总生存期 (OS)、无病生存期 (DFS)/无进展生存期 (PFS)/无复发生存期 (RFS) 和 3/4 级不良事件 (AE) 使用随机效应模型汇总. 进行了间接比较以比较 FOLFIRINOX 与 gem-cap 和 gem-nab/P。使用 Cochran 的 Q 检验和I ²统计量评估异质性。结果：确定了九项研究，涉及 6,564 名患者。间接比较显示 FOLFIRINOX 具有明显更好的 OS（可切除：HR 0.78 [0.61-0.99]；晚期：HR 0.71 [0.60-0.85]）和 RFS/DFS/PFS（可切除：HR 0.67 [0.55-0.82]；晚期：HR 0.65） [0.57-0.74]) 与 gem-cap 和 OS（可切除：HR 0.78 [0.61-1.00]；高级：HR 0.73 [0.54-0.98]）和 DFS/PFS（可切除：HR 0.66 [0.53-0.82]）相比；高级：与 gem-nab/P 相比，HR 0.64 [0.49–0.83])。与 gem-cap 和 gem-nab/P 相比，FOLFIRINOX 增加了 3/4 级 AE 风险。结论：与 gem-nab/P 和 gem-cap 相比，FOLFIRINOX 具有显着的生存获益。然而，重要的是要考虑与 FOLFIRINOX 相关的 3/4 级 AE 风险增加。
肿瘤资源治疗