Meta-analysis and indirect treatment comparison of modified FOLFIRINOX and gemcitabine plus nab-paclitaxel as first-line chemotherapy in advanced pancreatic cancer
Abstract Background: Modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NAB) have been recommended as first-line therapies for advanced pancreatic cancer (PC) at present. Due to the lack of direct comparison, we conducted this network meta-analysis to indirectly compare the effectiveness and toxicity of modified FOLFIRINOX and GEM-NAB. Methods: The eligible retrospective studies of treatments related to modified FOLFIRINOX and GEM-NAB were searched up to 4 April 2020. We used the frequentist model to analyze the survival and toxicity data between different treatments. Pooled analysis for overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and events of toxicity were analyzed in this study.Results: Twenty-two studies including 6351 patients were involved in this network meta-analysis. The comparisons based on OS and PFS showed that modified FOLFIRINOX and GEM-NAB had similar treatment efficacy. But GEM-NAB was more effective than modified FOLFIRINOX based on the result of ORR (RR: 0.70; 95% CI: 0.51-0.96). Moreover, our analysis showed a similar toxicity profile between modified FOLFIRINOX and GEM-NAB. Conclusions: Based on current evidence, modified FOLFIRINOX and GEM-NAB were similar in survival and toxicity comparisons. Many factors should be considered for the optimal treatment formulation and our meta-analysis could provide some guidance to treatment selection in the first-line setting for advanced PC.