Comparison of gemcitabine plus nab-paclitaxel and FOLFIRINOX in metastatic pancreatic cancer

BACKGROUND Gemcitabine plus nab-paclitaxel (GA) and modified FOLFIRINOX (FFX) have been widely used as standard first-line treatment in pancreatic cancer. However, it is unclear which regimen is more efficacious. AIM To evaluate a retrospective analysis comparing the efficacy and safety of FFX and GA as first-line chemotherapeutic regimens in patients with metastatic pancreatic cancer. METHODS We retrospectively analyzed and compared outcomes in 101 patients who presented with pancreatic cancer and were treated with either GA (n= 54) or FFX (n= 47). Moreover, we performed subgroup analysis based on the neutrophil/lymphocyte ratio (NLR) and Eastern Cooperative Oncology Group (ECOG) performance status. RESULTS There were no significant differences between two groups in baseline characteristics, except for the ECOG performance status. The median progression-free survival (PFS) (6.43 movs4.90 mo,P= 0.058) was comparable between two groups; however, median overall survival (OS) (10.17 movs6.93 mo,P= 0.008) was longer in patients who received GA regimen. In patients with ECOG 0 (PFS: 8.93 movs5.43 mo,P= 0.002; OS: 16.10 movs6.97 mo,P= 0.000) and those with NLR < 3 (PFS: 8.10 movs6.57 mo,P= 0.008; OS: 12.87 movs9.93 mo,P= 0.002), GA regimen showed higher efficacy. CONCLUSION GA regimen may be recommended to the patients with NLR < 3 or ECOG 0 status although GA and FFX showed comparable efficacy outcomes in patients with metastatic pancreatic cancer.