World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Review

Volume 14, Number 5, October 2023, pages 325-339

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

Figures

Figure 1.
Figure 1. Potential biomarkers in nab-paclitaxel/gemcitabine (a), Folfirinox (b) regimens of drug metabolism and mechanism of action. (c) Macrophages induce gemcitabine resistance by up-regulation of CDA.
Figure 2.
Figure 2. (a) Forest plot of OS (HR: 0.93; 95% CI: 0.83 - 1.04; P = 0.0001). (b) Funnel plot of OS. HR: hazard ratio; CI: confidence interval; OS: overall survival.
Figure 3.
Figure 3. (a) Forest plot of PFS (HR: 0.88; 95% CI: 0.81 - 0.97; P < 0.0001). (b) Funnel plot of PFS. PFS: progression-free survival; HR: hazard ratio; CI: confidence interval.
Figure 4.
Figure 4. (a) Forest plot of objective response rate (OR: 0.90; 95% CI: 0.64 - 1.27; P = 0.15). (b) Funnel plot of objective response rate. OR: odds ratio; CI: confidence interval.
Figure 5.
Figure 5. (a) Forest plot of anemia (OR: 0.70; 95% CI: 0.51 - 0.98; P = 0.10). (b) Funnel plot of anemia. OR: odds ratio; CI: confidence interval.
Figure 6.
Figure 6. (a) Forest plot of neutropenia (OR: 1.10; 95% CI: 0.92 - 1.31; P = 0.33). (b) Funnel plot of neutropenia. OR: odds ratio; CI: confidence interval.
Figure 7.
Figure 7. (a) Forest plot of thrombocytopenia (OR: 0.83; 95% CI: 0.60 - 1.13; P = 0.23). (b) Funnel plot of thrombocytopenia.
Figure 8.
Figure 8. (a) Forest plot of diarrhea (OR: 1.96; 95% CI: 1.22 - 3.15; P = 0.001). (b) Funnel plot of diarrhea. OR: odds ratio; CI: confidence interval.

Tables

Table 1. Study and Patient Characteristics
 
AuthorYear of publicationCountryStart timeEnd timePSNumber of patientsMedian ageMales (%)Median follow-upTreatment
USA: United States of America; PS: performance status; NA: not applicable; GEM-NAB: gemcitabine + nab-paclitaxel.
Nakazawa et al [32]2019Japan2013.122018.60 - 29268NA14.9 months (0.7 - 30.9)GEM-NAB
11961NA13.1 months (1.3 - 40.8)Folfirinox
Kim et al [29]2018USA2015.42015.120 - 433764.5964.7%10.7 monthsGEM-NAB
31759.0367.2%Folfirinox
Muranaka et al [34]2017Japan2013.122015.90 - 12266.554.5%8.3 monthsGEM-NAB
166362.5%11.9 monthsFolfirinox
Papneja et al [33]2019Canada201120160 - 3336452%8 monthsGEM-NAB
865962%Folfirinox
Cho et al [35]2018Korea2015NANA8154NA7.9 months (1.5 - 23.4)GEM-NAB
8665NAFolfirinox
Williet et al [24]2019France2015.62018.60 - 210968.149.5%NAGEM-NAB
10761.859.8%Folfirinox
Chan et al [27]2019Canada2015.42017.3NA49869.1460.2%NAGEM-NAB
63261.8354.6%Folfirinox
Barrera et al [26]2019Canada20102018NA41NANANAGEM-NAB
60NANAFolfirinox
60NANAGEM
Longo Munoz et al [31]2019Spain2011.12018.5NANANANANAGEM-NAB
Chun et al [28]2021Korea2011.52019.30 - 21516460.3%33 monthsGEM-NAB
1516255.6%Folfirinox
Rapposelli et al [19]2021NA2014.12020.120 - 22686261.9%21.8 monthsGEM-NAB
1716162%Folfirinox
Lee et al [30]2020South Korea2011.72017.120 - 21816953%NAGEM-NAB
2326061%Folfirinox
Riedl et al [20]2021Austria2010.82019.100 - 12977059%26.2 monthsGEM-NAB
1586359%Folfirinox
Sigel et al [23]2022NA20032016NA3176698%NAGEM-NAB
3536194%Folfirinox
Ay et al [17]2022NA2010.12020.120 - 1796149.4%NAGEM-NAB
1035860.2%Folfirinox
Santucci et al [21]2022Australia and New Zealand201620200 - 43756752.7%8.7 monthsGEM-NAB
735960.3%6.3 monthsFolfirinox
Yoshida et al [25]2022Japan2001.42017.120 - 22862.557.1%9.4 monthsGEM-NAB
1056.590%Folfirinox
Pijnappel et al [18]2022Netherlands201520180 - 42076950%4.1 monthsGEM-NAB
10296254%Folfirinox
Arima et al [16]2021Japan2013.122017.30 - 2476861.7%14.2 monthsGEM-NAB
166556.3%Folfirinox
Templeton et al [36]2020Canada201120170 - 11066.970%15 monthsGEM-NAB
1062.670%Folfirinox
Servetto et al [22]2022Italy2011.22020.110 - 111763.757.3%NAGEM-NAB
4353.665.1%Folfirinox

 

Table 2. Demographic Details of the Study and Patient Characteristics
 
AuthorGEM-NABFolfirinoxGEM-NABFolfirinox
MaleFemaleMaleFemaleHeadBodyTailHeadBodyTail
GEM-NAB: gemcitabine + nab-paclitaxel.
Chun et al [28]9160846733--37--
Rapposelli et al [19]166102106651058370675345
Lee et al [30]968514191635255855973
Riedl et al [20]17412394641755739743832
Sigel et al [23]312533320------
Ay et al [17]39406241------
Santucci et al [21]19817844292098070401416
Chan et al [27]300198345287------
Yoshida et al [25]161291------
Pijnappel et al [18]104103556473804649393212270
Arima et al [16]291897------
Templeton et al [36]737391-82-
Servetto et al [22]6750281562--17--
Nakazawa et al [32]----------
Kim et al [29]21811921310417093821638374
Muranaka et al [34]1210106------
Papneja et al [33]171653332462501318
Cho et al [35]----------
Williet et al [24]54556443512830472634
Barrera et al [26]----------
Longo Munoz et al [31]----------

 

Table 3. Study Criteria and Guidelines
 
AuthorGuidelinesSafety criteria
CTCAE: Common Terminology Criteria for Adverse Events; NA: not available.
Chun et al [28]Good Clinical Practice guidelines and the Declaration of HelsinkiCTCAE
Rapposelli et al [19]Good Clinical Practice guidelines and the Declaration of HelsinkiCTCAE
Lee et al [30]NACTCAE
Riedl et al [20]Local and National guidelinesNA
Sigel et al [23]Declaration of HelsinkiNA
Ay et al [17]Declaration of HelsinkiCTCAE
Santucci et al [21]Declaration of HelsinkiNA
Chan et al [27]NANA
Yoshida et al [25]The Declaration of HelsinkiNA
Pijnappel et al [18]Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelinesNA
Arima et al [16]The Declaration of HelsinkiCTCAE
Templeton et al [36]
Servetto et al [22]Good Clinical Practice guidelines and the Declaration of HelsinkiCTCAE
Nakazawa et al [32]NANA
Kim et al [29]NANA
Muranaka et al [34]The Declaration of HelsinkiCTCAE
Papneja et al [33]NANA
Cho et al [35]NANA
Williet et al [24]The Declaration of HelsinkiNational Cancer Institute CTCAE
Barrera et al [26]NANA
Longo Munoz et al [31]NANA