Modified FOLFIRINOX improves survival compared to gemcitabine in resected pancreatic cancer

Rákkutatás · Pancreatic cancer

Modified FOLFIRINOX leads to significantly longer disease‑free and overall survival than gemcitabine among patients with resected pancreatic cancer, though with higher toxicity.

In a phase‑3 randomized trial of 493 patients with resected pancreatic ductal adenocarcinoma, a modified FOLFIRINOX regimen (oxaliplatin 85 mg/m², irinotecan 180 mg/m² (reduced to 150 mg/m² after safety analysis), leucovorin 400 mg/m², and fluorouracil 2400 mg/m² every 2 weeks) was compared with gemcitabine (1000 mg/m² on days 1, 8, and 15 every 4 weeks) for 24 weeks. Median disease‑free survival was 21.6 months versus 12.8 months (HR 0.58; 95% CI 0.46‑0.73; P<0.001), and median overall survival was 54.4 versus 35.0 months (HR 0.64; 95% CI 0.48‑0.86; P=0.003). The 3‑year disease‑free survival rate was 39.7% versus 21.4%, and overall survival rate was 63.4% versus 48.6%. Grade 3/4 adverse events occurred in 75.9% vs 52.9% of patients; a gemcitabine patient died of interstitial pneumonitis. The study demonstrates superior efficacy of modified FOLFIRINOX with an acceptable safety profile.

This study provides robust evidence that adjuvant modified FOLFIRINOX confers a survival benefit over gemcitabine in patients with resected pancreatic cancer, informing clinical decision‑making and guideline development for this highly aggressive malignancy.

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