Evidence map›Paper›PMID 37020094›Full record

SynthesisAnnals of surgical oncology2023

FOLFIRINOX or Gemcitabine-based Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Multi-institutional, Patient-Level, Meta-analysis and Systematic Review.

Dilmurodjon Eshmuminov, Botirjon Aminjonov, Russell F Palm, Giuseppe Malleo, Ryan K Schmocker, Raëf Abdallah, Changhoon Yoo, Walid L Shaib, Marcel André Schneider, Elena Rangelova and 26 more

Open access · hybridAbstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of surgical oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 65 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed, 2 pooled it
15.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

65 citing papers in PubMed, 2 syntheses or guidelines pooled it, 67 citations in OpenAlex.

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5 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

36 authors at 20 institutions in 10 countries.

Dilmurodjon EshmuminovDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Botirjon AminjonovDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Russell F PalmDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
Giuseppe MalleoUnit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
Ryan K SchmockerDepartment of Surgery, The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Raëf AbdallahHepatogastroenterology and Gastrointestinal Oncology Department, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
Changhoon YooDepartment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Walid L ShaibDepartment of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Marcel André SchneiderDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Elena RangelovaDepartment of Upper Gastrointestinal Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology (CLINTEC) at Karolinska Institute, Stockholm, Sweden.
Yoo Jin ChoiDepartment of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Hongbeom KimDepartment of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
J Bart RoseDivision of Surgical Oncology, Pancreatobiliary Disease Center at UAB, The University of Alabama at Birmingham, Birmingham, USA.
Sameer PatelDivision of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Gregory C WilsonDivision of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Sarah MaloneyDepartment of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
Lea TimmermannDepartment of Surgery, Charité - Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Klaus SahoraDepartments of Surgery and Comprehensive Cancer Center, University of Vienna, Medical University of Vienna, Vienna, Austria.
Fabian RösslerDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Víctor Lopez-LopezDepartment of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
Emanuel BoyerUniversity of South Florida School of Medicine, Tampa, FL, USA.
Laura MagginoUnit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
Thomas MalinkaDepartment of Surgery, Charité - Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Jeong Youp ParkDivision of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Matthew H G KatzUniversity of Texas MD Anderson Cancer Center, Houston, TX, USA.
Laura PrakashUniversity of Texas MD Anderson Cancer Center, Houston, TX, USA.
Syed A AhmadDivision of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Scott HeltonSection of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Jin-Young JangDepartment of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Sarah E HoffeDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
Roberto SalviaUnit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
Julien TaiebHepatogastroenterology and Gastrointestinal Oncology Department, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
Jin HeDepartment of Surgery, The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Pierre-Alain ClavienDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Ulrike HeldDepartment of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
Kuno LehmannDepartment of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland. kuno.lehmann@usz.ch.
University Hospital of Zurich · CHSeoul National University · KRUniversity of Cincinnati · USUniversity of Verona · ITUniversity of Zurich · CHHôpital Européen Georges-Pompidou · FRJohns Hopkins Hospital · USMoffitt Cancer Center · USThe University of Texas MD Anderson Cancer Center · USAsan Medical Center · KRCharité - Universitätsmedizin Berlin · DEEmory University · USFreie Universität Berlin · DEHospital Universitario Virgen de la Arrixaca · ESMedical University of Vienna · ATRoyal North Shore Hospital · AUUniversity of Alabama at Birmingham · USUniversity of Gothenburg · SEUniversity of South Florida · USVirginia Mason Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPancreatic cancer often presents as locally advanced (LAPC) or borderline resectable (BRPC). Neoadjuvant systemic therapy is recommended as initial treatment. It is currently unclear what chemotherapy should be preferred for patients with BRPC or LAPC.

methodsWe performed a systematic review and multi-institutional meta-analysis of patient-level data regarding the use of initial systemic therapy for BRPC and LAPC. Outcomes were reported separately for tumor entity and by chemotherapy regimen including FOLFIRINOX (FIO) or gemcitabine-based.

resultsA total of 23 studies comprising 2930 patients were analyzed for overall survival (OS) calculated from the beginning of systemic treatment. OS for patients with BRPC was 22.0 months with FIO, 16.9 months with gemcitabine/nab-paclitaxel (Gem/nab), 21.6 months with gemcitabine/cisplatin or oxaliplatin or docetaxel or capecitabine (GemX), and 10 months with gemcitabine monotherapy (Gem-mono) (p < 0.0001). In patients with LAPC, OS also was higher with FIO (17.1 months) compared with Gem/nab (12.5 months), GemX (12.3 months), and Gem-mono (9.4 months; p < 0.0001). This difference was driven by the patients who did not undergo surgery, where FIO was superior to other regimens. The resection rates for patients with BRPC were 0.55 for gemcitabine-based chemotherapy and 0.53 with FIO. In patients with LAPC, resection rates were 0.19 with Gemcitabine and 0.28 with FIO. In resected patients, OS for patients with BRPC was 32.9 months with FIO and not different compared to Gem/nab, (28.6 months, p = 0.285), GemX (38.8 months, p = 0.1), or Gem-mono (23.1 months, p = 0.083). A similar trend was observed in resected patients converted from LAPC.

conclusionsIn patients with BRPC or LAPC, primary treatment with FOLFIRINOX compared with Gemcitabine-based chemotherapy appears to provide a survival benefit for patients that are ultimately unresectable. For patients that undergo surgical resection, outcomes are similar between GEM+ and FOLFIRINOX when delivered in the neoadjuvant setting.

Indexed as

GemcitabinePancreatic NeoplasmsAntineoplastic Combined Chemotherapy ProtocolsFluorouracilHumansIrinotecanLeucovorinMulticenter Studies as TopicNeoadjuvant TherapyOxaliplatinPaclitaxelFluorouracilfolfirinoxGemcitabineIrinotecanLeucovorinOxaliplatinPaclitaxel

Identifiers

PMID37020094
PMCPMC10250524
OpenAlexW4362640458

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.