First-Line FOLFIRINOX vs Gemcitabine ± Nab-Paclitaxel in Metastatic Pancreatic Adenocarcinoma: Real-World Treatment Response and Clinicopathologic Predictors from a 2022 Tertiary-Center Cohort

• Farah Nabil

  Medical Oncology Department, Anbar Cancer , Anbar, Ramadi, Iraq.

• Mohammed Saleem

  Medical City Complex, Baghdad Teaching Hospital, Baghdad, Iraq.

The majority of cases of pancreatic ductal adenocarcinoma (PDAC) manifest at a metastatic stage, and the optimal first-line regimen in real-world practice remains the subject of debate. The objective of this study is to compare radiologic response and progression risk across first-line regimens and to evaluate clinicopathologic predictors of outcome in metastatic PDAC. A retrospective cohort study was conducted at the Oncology Teaching Hospital in Baghdad in 2022. The patients were administered FOLFIRINOX, gemcitabine (Gem), or gemcitabine in combination with nab-paclitaxel (GnP). The assessment of outcomes was conducted following the completion of four cycles utilizing the RECIST criteria. Serum CA19‑9 levels were measured prior to and following treatment. Group comparisons employed the appropriate parametric or non-parametric tests, while univariate logistic regression was utilized to estimate odds of progression. The findings indicated that 60 patients were included in the study (mean age 57.9 ± 9.8; 75% male). The median value of CA19‑9 decreased from 213.5 to 83.5 U/mL (P<0.001). By regimen, partial response was most frequent with FOLFIRINOX (77.3%), whereas progression predominated with Gem (72.2%); GnP showed mixed responses. In univariate models, FOLFIRINOX was associated with a reduced likelihood of progression (odds ratio [OR] 0.09; 95% confidence interval [CI] 0.01–0.37), while Gem was associated with an increased likelihood of progression (OR 26.0; 95% CI 5.19–207). The following factors were identified as adverse: age, male sex, hypertension, active smoking, and poor differentiation. In this real-world cohort, FOLFIRINOX demonstrated superior disease control in comparison to Gem or GnP. Clinicopathologic features may refine regimen selection in metastatic PDAC.

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