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Which Chemotherapy Works Better for Advanced Pancreatic Cancer?

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Modified Fluorouracil, Leucovorin, Irinotecan, and Oxaliplatin or S-1, Irinotecan, and Oxaliplatin Versus Nab-Paclitaxel + Gemcitabine DOI- 10.1200JCO.24.00936

People with advanced or returning pancreatic cancer usually need strong chemotherapy to control the disease. Doctors often choose between a few different combinations of drugs. This study tested three of them to see which one helps people live longer.

The trial involved over 500 patients across 45 hospitals in Japan. It compared:

⦿ mFOLFIRINOX, a common but intense chemotherapy mix

⦿ S-IROX, a newer combination using an oral drug called S-1

⦿ Nab-paclitaxel plus gemcitabine, another standard treatment

The goal was to find which option gave the best overall survival.

Results showed:

⦿ Patients on nab-paclitaxel plus gemcitabine lived the longest—17.1 months on average.

⦿ Patients on mFOLFIRINOX and S-IROX lived about 14 months.

⦿ Side effects like severe appetite loss were more common with the other two treatments.

Because the two newer options did not outperform nab-paclitaxel plus gemcitabine—and caused more side effects—the trial was stopped early.

This study confirms that nab-paclitaxel plus gemcitabine remains the best first-line treatment for many people with advanced pancreatic cancer. If you or a loved one are facing treatment choices, this option may offer the best chance for both longer survival and fewer side effects.

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Dr Harsh Shah - GI & HPB Oncosurgeon in Ahmeadbad
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