Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Comparison of first-line chemotherapy regimens in unresectable locally advanced or metastatic pancreatic cancer: a systematic review and Bayesian network meta-analysis,” published in the November 2024 issue of Oncology by Mastrantoni et al.    

Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed in advanced, unresectable stages, and first-line chemotherapy is the standard treatment approach.  

Researchers conducted a retrospective study to compare first-line chemotherapy regimens for patients with advanced PDAC.  

They searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and oncology meeting websites (Nov 15, 2023). Phase 2–3 RCTs published after Jan 1, 2000, evaluating first-line treatments in previously untreated, unresectable, locally advanced, or metastatic patients with PDAC. Primary outcomes were progression-free survival (PFS) and OS. A Bayesian approach estimated HRs with 95% CIs, using the deviance information criterion to select between random-effects and fixed-effects models.  

The result showed 6,050 records and 79 RCTs (22,168 patients); for PFS (71 trials, 19,479 patients), the most effective treatments were gemcitabine plus nab-paclitaxel alternating folinic acid, fluorouracil, and oxaliplatin (FOLFOX) (HR 0.32, 95% CI 0.22–0.47), cisplatin, nab-paclitaxel, capecitabine, and gemcitabine (PAXG) (HR 0.35, 95% CI 0.22–0.55), and liposomal irinotecan combined with fluorouracil, leucovorin, and oxaliplatin (NALIRIFOX) (HR 0.43, 95% CI 0.34–0.54), followed by fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) (HR 0.55, 95% CI 0.47–0.65) and gemcitabine plus nab-paclitaxel (HR 0.62, 95% CI 0.54–0.72). Similar results were observed for OS (79 trials, 22,104 patients), with PAXG (HR 0.40, 95% CI 0.25–0.65), gemcitabine plus nab-paclitaxel alternating FOLFOX (HR 0.46, 95% CI 0.32–0.66), and NALIRIFOX (HR 0.56, 95% CI 0.45–0.70) showing the highest benefit, followed by FOLFIRINOX (HR 0.66, 95% CI 0.56–0.78) and gemcitabine plus nab-paclitaxel (HR 0.67, 95% CI 0.59–0.77). The overall risk of bias was low to some concerns, and the certainty of evidence was low. 

They concluded that NALIRIFOX and FOLFIRINOX should be preferred for patients who can tolerate the regimens, with gemcitabine plus nab-paclitaxel as a viable alternative for those unfit for triplet therapy.  

Source: thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00511-4/abstract