Chemotherapy in pancreatic ductal adenocarcinoma: when cytoreduction is the aim. A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (40 études, 2 883 patients), cette méta-analyse compare l'efficacité, du point de vue du taux de réponse complète, de deux stratégies de chimiothérapie chez des patients atteints d'un adénocarcinome canalaire pancréatique, l'une de FOLFIRINOX et l'autre de type GEM-NAB, dans un contexte curatif et palliatif
Backgroud : In pancreatic ductal adenocarcinoma cytoreduction can be curative, or palliative.FOLFIRINOX and GEM-NAB are the two FDA/EMA approved regimens for advanced disease.We aim to identified the most cytoreductive regimen on the basis of current literature. Material and methods : PUBMED was searched for studies published to April, 2021. Abstracts of annual meetings ASCO 2009 to 2021, and ESMO 2015 to 2020, were searched as well. Phase II, phase IIIclinical trials, prospective, observational and retrospective studies, reporting overall response rate (complete + partial response) (ORR) in patients treated either with FOLFIRINOX or GEM-NAB were included. The meta-analysis was performed using a randomized-effectsmodel. Main outcome was cytoreduction with each regimen reported as ORR according to RECIST. Results : Among 2183 studies identified, 40 fulfilled the selection criteria (22 FOLFIRINOX,18 GEM-NAB), totaling 2883 patients. Pooling of data found similar ORR between regimens:FOLFIRINOX [30% (95 CI 26-34%)] and GEM-NAB [30% (95 CI 26-35%),] P=0.928. Disease control rate (DCR) was significantly higher with FOLFIRINOX [85% (95CI 82-88%)] comparedto GEM-NAB [80% (95CI 77-84%)], P=0.012. A significantly higher ORR irrespective ofthe regimen was observed in stage IV [36% (95CI 32-40%)] versus stage II-III [25%(95CI 20-31%)], P=0.002. Conclusions and relevance : Our meta-analysis did not find significant superiority of one regimen over the otherin terms of RECIST-based cytoreduction both in palliative and curative setting of patients with pancreatic adenocarcinoma. The significantly better DCR with FOLFIRINOXcompared with GEM-NAB deserves further investigation including waterfall plot andcorrelations with potential predictive factors.