Meta-analysis of first-line NALIRIFOX, FOLFIRINOX, or GEM-NABP for metastatic pancreatic ductal adenocarcinoma

Combination chemotherapy is the standard of first-line care for metastatic pancreatic ductal adenocarcinoma (mPDAC). Meta-analysis of seven phase 3 trials compared efficacy and toxicity of first-line NALIRIFOX (fluorouracil, leucovorin, liposomal irinotecan, and oxaliplatine) versus FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) versus GEM-NAB (gemcitabine and nab-paclitaxel) for mPDAC. The figure shows that first-line NALIRIFOX and FOLFIRINOX were associated with similar PFS and OS while first-line GEM-NABP was associated with worse PFS and OS compared with NALIRIFOX and FOLFIRINOX. NALIRIFOX was associated with lower incidence of hematological events, but significantly higher rates of severe diarrhea compared with both other regimens. The authors conclude that NALIRIFOX and FOLFIRINOX may provide equal efficacy as first-line treatment of mPDAC, but with different toxicity profiles.