FOLFIRINOX vs. gemcitabine/nab-paclitaxel for metastatic pancreatic cancer: A real-world study
4 affiliations
- 1Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- 2Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
- 3Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- 4Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Abstract
Background: FOLFIRINOX and gemcitabine/nab-paclitaxel are widely used first-line regimens in metastatic pancreatic cancer (mPC); however, direct real-world comparisons and clear criteria for selecting between the two remain limited.
Methods: In this retrospective cohort study, we used a multicenter real-world data registry to compare outcomes between patients with mPC treated with FOLFIRINOX and gemcitabine/nab-paclitaxel and explore associations between genomic alterations and survival outcomes. The cohort included patients with mPC treated with FOLFIRINOX (n = 272) or gemcitabine/nab-paclitaxel (n = 280) between 2010 and 2022 at tertiary referral cancer centers. The primary outcomes were overall and progression-free survival. Available next-generation sequencing results were used to explore potential prognostic biomarkers.
Findings: The FOLFIRINOX group was significantly younger than the gemcitabine/nab-paclitaxel group. Before propensity score matching, the FOLFIRINOX group showed significantly longer median overall and progression-free survival. Afterward, survival outcomes no longer significantly differed. Next-generation sequencing panel data were available for 57 and 29 patients in the FOLFIRINOX and gemcitabine/nab-paclitaxel groups, respectively. In the gemcitabine/nab-paclitaxel group, ARID1A and RNF43 mutations were correlated with shorter progression-free survival. Genomic alterations in the TGF-β pathway were associated with longer overall survival with gemcitabine/nab-paclitaxel.
Interpretation: No statistically significant differences in OS or PFS were observed between FOLFIRINOX and gemcitabine/nab-paclitaxel after propensity score matching. The exploratory genomic associations require validation in larger prospective cohorts before their potential role in treatment selection can be established.
Funding: This work was supported by grants from the National Research Foundation of Korea (RS-2024–00,335,625, RS-2024–00,342,475, and NRF-2021R1A2C1008898), Korea Evaluation Institute of Industrial Technology (20,023,781), and Korea Health Technology R&D Project through the Korea Health Industry Development Institute (HI22C047400).
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BibTeX
@article{kim2026folfirinox,
title = {{FOLFIRINOX vs. gemcitabine/nab-paclitaxel for metastatic pancreatic cancer: A real-world study}},
author = {Jee Hoon Kim and See Young Lee and Galam Leem and Hee Seung Lee and Sung Ill Jang and Moon Jae Chung and Jeong Youp Park and Seungmin Bang and Seung Woo Park and Si Young Song and Jae Hee Cho and Jung Hyun Jo},
journal = {Translational Oncology},
year = {2026},
month = oct,
doi = {10.1016/j.tranon.2026.103085},
url = {https://doi.org/10.1016/j.tranon.2026.103085},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - FOLFIRINOX vs. gemcitabine/nab-paclitaxel for metastatic pancreatic cancer: A real-world study
AU - Jee Hoon Kim
AU - See Young Lee
AU - Galam Leem
AU - Hee Seung Lee
AU - Sung Ill Jang
AU - Moon Jae Chung
AU - Jeong Youp Park
AU - Seungmin Bang
AU - Seung Woo Park
AU - Si Young Song
AU - Jae Hee Cho
AU - Jung Hyun Jo
PY - 2026
DA - 2026/10/26
JO - Translational Oncology
DO - 10.1016/j.tranon.2026.103085
UR - https://doi.org/10.1016/j.tranon.2026.103085
AB - Background: FOLFIRINOX and gemcitabine/nab-paclitaxel are widely used first-line regimens in metastatic pancreatic cancer (mPC); however, direct real-world comparisons and clear criteria for selecting between the two remain limited. Methods: In this retrospective cohort study, we used a multicenter real-world data registry to compare outcomes between patients with mPC treated with FOLFIRINOX and gemcitabine/nab-paclitaxel and explore associations between genomic alterations and survival outcomes. The cohort included patients with mPC treated with FOLFIRINOX (n = 272) or gemcitabine/nab-paclitaxel (n = 280) between 2010 and 2022 at tertiary referral cancer centers. The primary outcomes were overall and progression-free survival. Available next-generation sequencing results were used to explore potential prognostic biomarkers. Findings: The FOLFIRINOX group was significantly younger than the gemcitabine/nab-paclitaxel group. Before propensity score matching, the FOLFIRINOX group showed significantly longer median overall and progression-free survival. Afterward, survival outcomes no longer significantly differed. Next-generation sequencing panel data were available for 57 and 29 patients in the FOLFIRINOX and gemcitabine/nab-paclitaxel groups, respectively. In the gemcitabine/nab-paclitaxel group, ARID1A and RNF43 mutations were correlated with shorter progression-free survival. Genomic alterations in the TGF-β pathway were associated with longer overall survival with gemcitabine/nab-paclitaxel. Interpretation: No statistically significant differences in OS or PFS were observed between FOLFIRINOX and gemcitabine/nab-paclitaxel after propensity score matching. The exploratory genomic associations require validation in larger prospective cohorts before their potential role in treatment selection can be established. Funding: This work was supported by grants from the National Research Foundation of Korea (RS-2024–00,335,625, RS-2024–00,342,475, and NRF-2021R1A2C1008898), Korea Evaluation Institute of Industrial Technology (20,023,781), and Korea Health Technology R&D Project through the Korea Health Industry Development Institute (HI22C047400).
SN - 1936-5233
ER -