Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis
Background: FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce toxicity. However, these studies lack a unified pattern for ‘planned’ dose modification, and the ‘actually administered’...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-06-01
|
| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/17588359231175441 |
| _version_ | 1827912452583456768 |
|---|---|
| author | Kwangrok Jung Suhyun Choi Hyunjoo Song Kyuhan Kwak Soyeon Anh Jae Hyup Jung Bomi Kim Jinwoo Ahn Jaihwan Kim Jin-Hyeok Hwang Jong-chan Lee |
| author_facet | Kwangrok Jung Suhyun Choi Hyunjoo Song Kyuhan Kwak Soyeon Anh Jae Hyup Jung Bomi Kim Jinwoo Ahn Jaihwan Kim Jin-Hyeok Hwang Jong-chan Lee |
| author_sort | Kwangrok Jung |
| collection | DOAJ |
| description | Background: FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce toxicity. However, these studies lack a unified pattern for ‘planned’ dose modification, and the ‘actually administered’ dose varied more. Objective: To map a 10-year trend for ‘planned’ and ‘actual’ doses of FOLFIRINOX and investigate the clinical outcomes according to dose modification. Data sources and methods: A comprehensive systematic literature search was conducted from January 2011 to September 2021. All studies for FOLFIRINOX as first-line treatment in MPC were considered. Selected studies were firstly classified according to prospective versus retrospective research, secondly standard versus modified FOLFIRINOX, and thirdly ‘planned’ versus ‘actual’ dose. For evidence-mapping for the trend of dose modification, we developed a web-based interactive bubble-plot program ( www.RDI-map.com ). Objective response rate (ORR) and hematologic toxicity were set as endpoints for the comparison of clinical outcomes according to dose modification. Results: A total of 37 studies were identified for evidence-mapping (11 prospective and 26 retrospective studies). There were 12 different types of ‘planned’ dose modification in FOLFIRINOX ranging 75–100% oxaliplatin, 75–100% irinotecan, 0–100% 5-fluorouracil (5-FU) bolus, and 75–133% 5-FU continuous injection. The ‘actual’ dose further decreased to 54–96%, 61–88%, 0–92%, and 63–98%, respectively. For the standard versus modified FOLFIRINOX, the ORR was 28.2% (95% CI: 22.5–33.9%) and 33.8% (95% CI: 30.3–37.3%), respectively ( p = 0.100), and the incidence of febrile neutropenia was 11.6% (95% CI: 0–16.0%) and 5.5% (95% CI: 0–8.9%), respectively ( p = 0.030). Conclusions: RDI-map.com enables multifactorial evidence-mapping for practical FOLFIRINOX dose reduction. The pattern of dose modification was not consistent across studies, and there was a significant gap between the ‘planned’ and ‘actual’ doses. Modified FOLFIRINOX showed similar efficacy to the standard regimen with reduced incidence of febrile neutropenia. |
| first_indexed | 2024-03-13T02:16:01Z |
| format | Article |
| id | doaj.art-6b1ec99d35654bffb71305ea7a6d22ae |
| institution | Directory Open Access Journal |
| issn | 1758-8359 |
| language | English |
| last_indexed | 2024-03-13T02:16:01Z |
| publishDate | 2023-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj.art-6b1ec99d35654bffb71305ea7a6d22ae2023-06-30T13:04:16ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592023-06-011510.1177/17588359231175441Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysisKwangrok JungSuhyun ChoiHyunjoo SongKyuhan KwakSoyeon AnhJae Hyup JungBomi KimJinwoo AhnJaihwan KimJin-Hyeok HwangJong-chan LeeBackground: FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce toxicity. However, these studies lack a unified pattern for ‘planned’ dose modification, and the ‘actually administered’ dose varied more. Objective: To map a 10-year trend for ‘planned’ and ‘actual’ doses of FOLFIRINOX and investigate the clinical outcomes according to dose modification. Data sources and methods: A comprehensive systematic literature search was conducted from January 2011 to September 2021. All studies for FOLFIRINOX as first-line treatment in MPC were considered. Selected studies were firstly classified according to prospective versus retrospective research, secondly standard versus modified FOLFIRINOX, and thirdly ‘planned’ versus ‘actual’ dose. For evidence-mapping for the trend of dose modification, we developed a web-based interactive bubble-plot program ( www.RDI-map.com ). Objective response rate (ORR) and hematologic toxicity were set as endpoints for the comparison of clinical outcomes according to dose modification. Results: A total of 37 studies were identified for evidence-mapping (11 prospective and 26 retrospective studies). There were 12 different types of ‘planned’ dose modification in FOLFIRINOX ranging 75–100% oxaliplatin, 75–100% irinotecan, 0–100% 5-fluorouracil (5-FU) bolus, and 75–133% 5-FU continuous injection. The ‘actual’ dose further decreased to 54–96%, 61–88%, 0–92%, and 63–98%, respectively. For the standard versus modified FOLFIRINOX, the ORR was 28.2% (95% CI: 22.5–33.9%) and 33.8% (95% CI: 30.3–37.3%), respectively ( p = 0.100), and the incidence of febrile neutropenia was 11.6% (95% CI: 0–16.0%) and 5.5% (95% CI: 0–8.9%), respectively ( p = 0.030). Conclusions: RDI-map.com enables multifactorial evidence-mapping for practical FOLFIRINOX dose reduction. The pattern of dose modification was not consistent across studies, and there was a significant gap between the ‘planned’ and ‘actual’ doses. Modified FOLFIRINOX showed similar efficacy to the standard regimen with reduced incidence of febrile neutropenia.https://doi.org/10.1177/17588359231175441 |
| spellingShingle | Kwangrok Jung Suhyun Choi Hyunjoo Song Kyuhan Kwak Soyeon Anh Jae Hyup Jung Bomi Kim Jinwoo Ahn Jaihwan Kim Jin-Hyeok Hwang Jong-chan Lee Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis Therapeutic Advances in Medical Oncology |
| title | Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis |
| title_full | Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis |
| title_fullStr | Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis |
| title_full_unstemmed | Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis |
| title_short | Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis |
| title_sort | real world dose reduction of standard and modified folfirinox in metastatic pancreatic cancer a systematic review evidence mapping and meta analysis |
| url | https://doi.org/10.1177/17588359231175441 |
| work_keys_str_mv | AT kwangrokjung realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT suhyunchoi realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT hyunjoosong realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT kyuhankwak realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT soyeonanh realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT jaehyupjung realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT bomikim realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT jinwooahn realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT jaihwankim realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT jinhyeokhwang realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis AT jongchanlee realworlddosereductionofstandardandmodifiedfolfirinoxinmetastaticpancreaticcancerasystematicreviewevidencemappingandmetaanalysis |