| Objective: This study aimed to compare the characteristics of FOLFIRINOX and Gemcitabine plus Nab-Paclitaxel in the treatment of pancreatic cancer through a meta-analysis of relevant literature studies,focusing on the efficacy and safety evaluation of the two regimens in chemotherapy and neoadjuvant chemotherapy,so as to provide partial reference for the selection of clinical chemotherapy regimens.Methods: We searched PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Data Resource Database,China Biomedical Literature Database and other databases for retrieval,and retrieved literatures from the establishment of the database to January 2021.According to the established inclusion and exclusion criteria,the literature was screened by two independent researchers and the quality was assessed independently.The primary outcome indicators included objective response rate,surgical resection rate and R0 resection rate,while the secondary outcome indicators included the need for second-line treatment rate and the incidence of toxic reactions,etc.Data extraction table is used to extract the target data in the study,and Rev Man5.3 software is used for statistical analysis.Results: A total of 18 studies were included in the analysis,17 of which were retrospective studies and 1 cohort study.2266 were treated with Folfirinox and 2029 with GEM-NAB.The analysis found:FOLFIRINOX had better benefits than GEM-NAB in ORR(viable surgical intervention subgroup and BRPC/LAPC staging,OR=1.73,95%CI=1.09-2.74,P=0.02,OR=1.95,95%CI=1.20-3.17,P=0.007),one-year survival(OR=1.78,95%CI=1.15-2.75,P=0.01),Second-line treatment was more likely in the FOLFIRINOX group than in the GEM-NAB group(OR=1.85,95%CI=1.04-3.29,P=0.04).There were no significant differences in surgical resection rate and R0 resection rate between the two groups(OR=1.60,95%CI=0.71-3.62,P=0.26,OR=1.23,95%CI=0.72-2.11,P=0.45,respectively).In terms of toxicity,the overall incidence of neutropenia did not differ between the two regimens(OR=0.95,95%CI=0.76-1.19,P=0.66),and in the subgroup analysis of grade 3-4 toxicity,the FOLFIRINOX group was more likely to develop grade 3-4 neutropenia than the GEM-NAB group(OR=1.57,95%CI=1.22-2.03,P=0.0005).In both the total toxicity subgroup and grade 3-4 toxicity subgroup analysis,the FOLFIRINOX group was more prone to nausea and vomiting than the GEM-NAB group(OR=2.52,95%CI=1.59-3.98,P < 0.0001,OR=3.69,95%CI=1.82-7.49,P=0.0003,respectively).In the overall toxicity subgroup analysis,the GEM-NAB group was more likely than the FOLFIRINOX group to have thrombocytopenia and to reduce OR discontinue chemotherapy due to toxicity(OR=0.61,95%CI=0.38-0.99,P=0.04,OR=0.58,95%CI=0.37-0.90,P=0.02,respectively).In the subgroup analysis of grade 3-4 toxicity,the GEM-NAB group was more prone to neurotoxic reactions than the FOLFIRINOX group(OR=0.31,95%CI=0.14-0.68,P=0.003).There was no significant difference in the incidence of anemia,diarrhea and fatigue between the two groups.Conclusions: FOLFIRINOX improves ORR and one-year survival compared to GEM-NAB in BRPC/LAPC patients undergoing neoadjuvant chemotherapy.However,in the overall population of patients with advanced pancreatic cancer,the FOLFIRINOX regimen had a higher rate of requiring second-line chemotherapeutic agents,while there was no statistically significant difference between the two regimens.In terms of toxicity,grade 3-4 neutropenia,nausea,and vomiting were more common in FOLFIRINOX regimen than in GEM-NAB regimen.The GEM-NAB regimen was more likely than the FOLFIRINOX regimen to have thrombocytopenia,neurotoxic reactions,and reduction or discontinuation of chemotherapy due to toxic reactions. |
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