Khan Arif Mohammed, Muddu Vamshi Krishna, Bonda Naga Avinash, Siripurapu Indraja, Ahmed Rimsha, Takreem Safa, Shahnoor Syeda Sana, Noor Sobia, Krishnaiah Sannapaneni, Rao G V, Reddy D Nageshwar
Department of Medical Oncology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, 500082, Hyderabad, India.
Department of Medical Oncology, AIG Hospitals, Hyderabad, India.
J Gastrointest Cancer. 2025 Aug 16;56(1):173. doi: 10.1007/s12029-025-01287-9.
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).
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.
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).
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.
胰腺癌是最致命的恶性肿瘤之一，在不同疾病阶段比较一线化疗方案的真实世界数据有限。FOLFIRINOX方案和吉西他滨联合白蛋白结合型紫杉醇（G+P）是标准治疗方案，具有不同的毒性特征和疗效。本研究评估了这些方案在转移性、局部晚期（LAPC）和临界可切除胰腺癌（BRPC）中的疗效和安全性。
我们对2019年10月至2023年11月在印度一家三级中心接受治疗的150例患者进行了回顾性研究。患者接受FOLFIRINOX方案（n=64）或G+P方案（n=86）作为一线治疗。亚组规模包括转移性（n=89）、LAPC（n=34）和BRPC（n=27）。评估的结局包括无进展生存期（PFS）、总生存期（OS）、无事件生存期（EFS）、缓解率、可切除性和毒性。采用Kaplan-Meier分析和Cox回归。亚组分析按疾病阶段和CA 19-9水平分层。
在转移性疾病中，中位OS为11个月（FOLFIRINOX方案）对比10个月（G+P方案；HR=1.26，p=0.38）；两组的PFS均为6个月。在LAPC中，OS分别为15.5个月和17个月（p=0.84）。在BRPC中，FOLFIRINOX方案显示出更优的OS（37个月对比16个月；p=0.02）和更高的手术转化率（66%对比39%）。≥3级毒性在FOLFIRINOX方案组中发生率为45%，在G+P方案组中为21%。CA 19-9升高（>37 U/mL）独立预测更差的OS（HR=1.72；p=0.029）。
FOLFIRINOX方案和G+P方案在转移性和局部晚期胰腺癌中疗效相当。FOLFIRINOX方案在BRPC中可带来生存获益，但毒性更高。
