Abstract
AIM: This study aimed to evaluate and compare the therapeutic efficacy and adverse effects of two sequential treatment strategies in patients with unresectable advanced pancreatic cancer (aPC), albumin-bound-paclitaxel plus gemcitabine administered follow by mFOLFIRINOX or SOXIRI (AG-F(S)FX(m)) versus the reverse sequence regimen F(S)FX(m)-AG. METHODS: In this retrospective analysis, patients with unresectable advanced pancreatic cancer (aPC) who received either AG-F(S)FX(m) or F(S)FX(m)-AG were included. Key endpoints were overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Survival outcomes were assessed using Kaplan-Meier curves, and differences between groups were examined through hazard ratios (HR) and corresponding p-values. RESULTS: A total of 107 patients were analyzed, including 49 who underwent AG-F(S)FX(m) and 58 who received F(S)FX(m)-AG. The median OS was 14.60 months for F(S)FX(m)-AG and 12.20 months for AG-F(S)FX(m) (HR: 1.04, 95% CI: 0.69-1.57, p= 0.86). Median PFS1, median PFS2 and median total PFS (tPFS) were 5.20 months versus 4.83 months (HR: 0.81, 95% CI: 0.54-1.21, p= 0.3), 4.53 months versus 5.77 months (HR: 1.15, 95% CI: 0.71-1.88, p= 0.60) and 13.80 months versus 12.80 months (HR: 0.90, 95% CI: 0.55-1.48, p= 0.67) for F(S)FX(m)-AG versus AG-F(S)FX(m). Given their comparable efficacy, we further compared the safety profiles of both regimens. The toxicity profiles differed between the two sequential treatments. Leukopenia was more common with first-line AG, while gastrointestinal toxicity, fatigue, and sensory neuropathy were more frequent with first-line F(S)FX(m). Additionally, elevated aspartate aminotransferase was more often reported with second-line AG. CONCLUSION: Both AG-F(S)FX(m) and F(S)FX(m)-AG demonstrated comparable efficacy in treating aPC, with F(S)FX(m)-AG showing a trend toward improved outcomes. The choice of sequential treatment should be guided by toxicity profiles and patient-specific factors. Further prospective studies are warranted to optimize treatment sequencing and personalize therapy for improved patient outcomes.