New Reference: Advanced Pancreatic Cancer Protocols

Randomized, open-label, phase II/III trial [GENERATE, JCOG1611]

Metastatic or recurrent pancreatic cancer

mFOLFIRINOX (n=175) vs S-IROX (n=176) vs nab-paclitaxel gemcitabine (n=176)

ORR: 35.4% vs 32.4% vs 42.4%

mOS: 17.1 mos vs 14.0 mos (HR 1.31 [0.97-1.77]) vs 13.6 mos (HR 1.35 [1.00-1.82])

mPFS: 6.7 mos vs 5.8 mos (HR 1.15 [0.91-1.45]) vs 6.7 mos (HR 1.07 [0.84-1.35])

Grade >=3 AE: neutropenia (60.3% vs 51.5% vs 38.7%), anorexia (5.2% vs 22.8% vs 27.6%), diarrhea (1.1% vs 8.8% vs 23.0%)

Treatment-related death: 0.2% (S-IROX)

Ohba A,Ozaka M,Mizusawa J Modified Fluorouracil, Leucovorin, Irinotecan, and Oxaliplatin versus S-1, Irinotecan, and Oxaliplatin versus Nab-Paclitaxel Gemcitabine in Metastatic or Recurrent Pancreatic Cancer

Reviewed by Elvin Chalabiyev, MD on Sep 3, 2025