Meta-analysis Of Modified FOLFIRINOX Regimens For Patients With Advanced Pancreatic Cancer

Purpose:In advanced pancreatic cancer chemotherapy,compared with gemcitabine chemotherapy regimens,on the basis of the improved FOLFIRNOX solution showed certain advantages,but the efficacy and safety of modified FOLFIRNOX scheme is better than gemcitabine based chemotherapy remains controversial,therefore,the aim of this study was evaluation by using the method of Meta-analysis FOLFIRNOX chemotherapy for advanced pancreatic cancer efficacy and safety.Methods:The literature search was conducted using the Pub Med,Cochrane Library,Embase,Web of Science,CNKI,CBM,Wan Fang and VIP,the retrieval time is from each database inception to December 2020.All randomized controlled trials(randomized controlled trials,RCTs)and non-randomized controlled studies(NRCSs)that met the inclusion criteria were collected.Two researchers independently conducted literature screening,selected studies that met the requirements based on established inclusion and exclusion criteria,and performed data extraction and quality assessment.The Review Manager 5.3 software was used for data synthesis.For dichotomous variables,risk ratio(RR)and 95%confidence interval(95%CI)were used for evaluation;continuous variables are described by mean difference(MD)and its 95%CI.Results:Of the 15 studies included in this meta-analysis,10 were prospective cohort studies,and 5 were retrospective cohort studies,including 818 patients who received a modified FOLFIRINOX chemotherapy program.The sample size included in the study was large,ranging from 16 cases to 247 cases.The results of meta-analysis showed that the incidence rate of neutropenia was 5%(95%CI=0.04-0.07),I~2=34.1%,P=0.1679.The incidence of thrombocytopenia was3%(95%CI=0.02-0.05),I~2=30.8%,P=0.1819.The incidence rate of diarrhea was 10%(95%CI=0.10-0.13,P<0.05).The incidence rate of G3-4 neurotoxicity was 7%(95%CI=0.05-0.09,P<0.05),I~2=0.00%,p=0.5644.The incidence rate of anorexia was7%(95%CI=0.05-0.09,P<0.05).The incidence rate of vertigo was 7%(95%CI=0.05-0.09),I~2=3.5%,P=0.3992.The incidence rate of anemia was 9%(95%CI=0.06-0.12,P<0.05).Median overall survival(median OS)and disease-free survival(PFS)were reported in all 15 articles,ranging from 7.0 to 54.4 months and 3.8 to 21.6 months,respectively.Conclusions:The modified FOLFIRINOX based chemotherapy regimen can improve the tumor remission rate and clinical benefit rate of patients with advanced pancreatic cancer to some extent,and improve the survival time of patients,so it can be used as a better scheme for the treatment of advanced pancreatic cancer.However,more large sample,multicenter and prospective studies are needed for the specific drug dosage,chemotherapy cycle and whether combined radiotherapy is needed.