Network meta-analysis of first-line chemotherapy regimens for unresectable locally advanced or metastatic pancreatic ductal adenocarcinoma

In advanced pancreatic ductal adenocarcinoma (PDAC), first-line chemotherapy is the standard of care. There are various available regimens, that have not been head-to-head compared in clinical trials. A network meta-analysis of phase 2 and 3 randomized controlled trials comparing activity of first-line regimens for unresectable, locally advanced, or metastatic PDAC was carried out. The analysis included 79 studies (a total of 22,168 patients) published between January 1, 2000, and November 15, 2023. The meta-analysis found that NALIRIFOX and FOLFIRINOX should be the preferred options for patients who can tolerate these regimens, with gemcitabine plus nab-paclitaxel as a viable alternative, particularly in patients unfit for triplet therapy.