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. 2026 Jan:232:116160.
doi: 10.1016/j.ejca.2025.116160. Epub 2025 Nov 29.

Metastatic pancreatic adenocarcinoma: Real-world efficacy of first line treatment

Mélanie Debiais  1 , Anthony Tarabay  2 , Sarah Blanchet-Deverly  2 , Géraldine M Camilleri  2 , Alexandre Megherbi  2 , Laura Diebakate  2 , Maxime Collin  2 , Antoine Hollebecque  3 , Cristina Smolenschi  3 , Marine Valéry  2 , Thomas Pudlarz  2 , Alina Cristina Fuerea  2 , Valérie Boige  2 , Michel Ducreux  4 , Alice Boilève  4
Affiliations

Metastatic pancreatic adenocarcinoma: Real-world efficacy of first line treatment

Mélanie Debiais et al. Eur J Cancer. 2026 Jan.

Abstract

Background: Metastatic pancreatic adenocarcinoma (mPDAC) has a poor prognosis. FOLFIRINOX (FFX) and gemcitabine nab-paclitaxel (GN) are the preferred first line (L1) regimens. We evaluated real-world outcomes of L1 therapies.

Methods: Retrospective analysis of all patients who received L1 chemotherapy for mPDAC between 2010 and 2024 at a single academic comprehensive cancer center.

Results: A total of 1012 patients were included: 48 % women, median age 63 years, 91 % ECOG 0-1. Synchronous metastases occurred in 66 % of patients. Liver (67 %), lung (20 %) and peritoneum (20 %) were the most frequent sites of metastasis. L1 regimens were FFX (n = 621, 61 %), gemcitabine (Gem) (141, 14 %), GN (78, 8 %), and others (n = 172, 17 %). Compared with GN, FFX recipients were younger (61 vs 65 years, p < 0.0001) with better ECOG (≥ 2 in 4 % vs 13 %, p < 0.0001). Median OS was 14.5 months (95 %CI [13.3-15.8]) with FFX, 12.4 [9.4-21.9] with GN, 7.9 [6.5-10.7] with Gem and 9.2 [7.2-13.1] with others (p < 0.0001). Respective median PFS were 7.0 months [95 %CI: 6.5-7.9], 5.4 [4.0-8.3], 4.9 [3.6-6.0] and 5.6 [3.6-7.0] (p < 0.05).

Conclusions: In this large real-world cohort, FFX was associated with superior response rate, PFS, and OS compared with other L1 regimens, supporting its use as standard first-line therapy for mPDAC.

Keywords: Chemotherapy; FOLFIRINOX; Metastases; Pancreatic adenocarcinoma.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michel Ducreux has received honoraria or consulting fees from companies including Roche, Sanofi, Pfizer, and Eli Lilly, involved in the development or commercialization of drugs evaluated in this study. Valérie Boige has received fees from Roche and Eli Lilly. Antoine Hollebecque has received fees from Pfizer and Servier. Alice Boilève has received fees from Servier, Merk, Seroni, Takeda and Ipsen. All other authors declare no conflicts of interest related to the molecules investigated in this work.

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