FOLFIRINOX vs. Gemcitabine Nab-Paclitaxel in Pancreatic Cancer: A Real-World Single-Center Analysis of Efficacy and Safety.

BACKGROUND

Pancreatic cancer is among the most lethal malignancies, with limited real-world data comparing frontline chemotherapy regimens across disease stages. FOLFIRINOX and gemcitabine plus nab-paclitaxel (G + P) are standard treatments with differing toxicity profiles and outcomes. This study evaluated the comparative efficacy and safety of these regimens in metastatic, locally advanced (LAPC), and borderline resectable pancreatic cancer (BRPC).

METHODS

We conducted a retrospective study of 150 patients treated between October 2019 and November 2023 at a tertiary center in India. Patients received FOLFIRINOX (n = 64) or G + P (n = 86) as first-line therapy. Subgroup sizes included metastatic (n = 89), LAPC (n = 34), and BRPC (n = 27). Outcomes assessed included progression-free survival (PFS), overall survival (OS), event-free survival (EFS), response rates, resectability, and toxicities. Kaplan-Meier analysis and Cox regression were used. Subgroup analyses were stratified by stage and CA 19-9 levels.

RESULTS

In metastatic disease, median OS was 11 months (FOLFIRINOX) vs. 10 months (G + P; HR = 1.26, p = 0.38); PFS was 6 months in both groups. In LAPC, OS was 15.5 vs. 17 months (p = 0.84). In BRPC, FOLFIRINOX showed superior OS (37 vs. 16 months; p = 0.02) and higher surgical conversion (66% vs. 39%). Grade ≥ 3 toxicities occurred in 45% (FOLFIRINOX) vs. 21% (G + P). Elevated CA 19-9 (> 37 U/mL) independently predicted worse OS (HR = 1.72; p = 0.029).

CONCLUSION

FOLFIRINOX and G + P have comparable efficacy in metastatic and locally advanced pancreatic cancer. FOLFIRINOX offers a survival benefit in BRPC but with higher toxicity.