Efficacy and safety of FOLFIRINOX versus gemcitabine-based regimens for treatment of metastatic pancreatic cancer: A systematic review and meta-analysis.
Bibliographic record
Abstract
e16393 Background: Metastatic pancreatic cancer (MPC) is an aggressive malignancy with limited treatment options. FOLFIRINOX, a combination regimen of folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin offers improved survival but with higher toxicity. In contrast, gemcitabine-based therapies remain the standard of care due to their manageable safety profile. This meta-analysis evaluates the efficacy and safety of these regimens to guide optimal MPC treatment strategies. Methods: A systematic review was conducted across six databases -- PubMed (MEDLINE), Google Scholar, ScienceDirect, PLOS ONE, Cochrane Library, and ClinicalTrials.gov-- up to January 17 2025. Thirteen retrospective studies and three randomized controlled trials (RCTs) were included, limited to Human studies in English. Bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Data analysis was performed using RevMan 5.4. Results: FOLFIRINOX-treated patients (n = 3,020) demonstrated significantly longer overall survival (OS) than gemcitabine-treated patients (n = 3,693), with a mean difference of 2.82 months (95% CI: 2.74–2.89; P < 0.00001). Progression-free survival (PFS) showed a smaller, non-significant difference of 0.18 months (95% CI: -0.09–0.46; P = 0.19). Severe neutropenia occurred significantly more frequently in the FOLFIRINOX group (n = 2,034) compared to gemcitabine-treated patients (n = 2,239), with an Odds Ratio of 1.49 (95% CI: 1.27–1.74; P < 0.00001). Conclusions: FOLFIRINOX improves OS and offers marginal PFS benefits over gemcitabine but at the cost of increased severe neutropenia. Its use should be considered for patients with good performance status, while further RCTs are necessary to refine patient selection and minimize toxicity. OS in patients on FOLFIRINOX and gemcitabine. Study OS [Months] with FOLFIRINOX SD [Months] FOLFIRINOX Total OS with Gemcitabine [Months] SD [Months] Gemcitabine Total Mean Difference [95% CI] Williet et al 14 23.21 49 9 10.72 49 5.00 [-2.16, 12.16] Santucci et al 12.3 1.59 73 11.3 3.56 73 1.00 [-0.49, 1.51] Riedl et al 10.1 3.27 158 10.1 4.48 297 0.00 [-0.72, 0.72] Rapposelli et al 11.1 10 171 9 9.48 268 0.00 [-1.88, 1.88] Papneja et al 9 9.45 86 9 14.08 86 0.00 [-5.20, 5.20] Ozaka et al 23 20.08 62 21.3 11.95 63 1.70 [-4.10, 7.50] Otsuka et al 11.5 1.62 102 11.1 1.99 153 0.40 [-0.05, 0.85] Muranaka et al 9.9 8.16 16 0 0 22 Not estimable Klein-Brill et al 9.37 1.04 566 6.84 1.19 536 2.53 [2.40, 2.66] Kim et al 13.8 2.72 317 8 2.81 337 1.70 [1.28, 2.12]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.021 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.034 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".