Comparative efficacy and safety of NALIRIFOX versus other first-line chemotherapy regimens in metastatic pancreatic ductal adenocarcinoma: a retrospective study

作者：Yuqi Wang, Jiayi Liu, Yi-Xiang Wang, Xiaoli Liu, Jingxin Zhang, Dawei Chen · 发表于：Therapeutic Advances in Medical Oncology · 年份：2026 · DOI：10.1177/17588359261449092 · 研究领域：Pancreatic and Hepatic Oncology Research、Renal cell carcinoma treatment、Cholangiocarcinoma and Gallbladder Cancer Studies

Background: Although gemcitabine plus nab-paclitaxel (Gem-NabP), modified FOLFIRINOX (mFOLFIRINOX), and NALIRIFOX are all recommended by current clinical guidelines as first-line treatment options for metastatic pancreatic ductal adenocarcinoma (mPDAC), the optimal regimen in real-world practice remains uncertain. Objective: To compare the efficacy and safety of different first-line chemotherapy regimens for mPDAC. Design: This was a single-center retrospective study. We included 215 patients with previously untreated mPDAC who received first-line chemotherapy at our institution between September 2023 and February 2025: Gem-NabP (n = 121), mFOLFIRINOX ( n = 55), and NALIRIFOX ( n = 39). Methods: The primary endpoints were progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR), while overall survival (OS) was a secondary endpoint. Tumor response was evaluated according to Response Evaluation Criteria in Solid Tumors version 1.1. Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Exploratory subgroup analyses were also performed. Results: NALIRIFOX showed the most favorable efficacy profile, with a median PFS of 9.0 months, a 6-month OS rate of 92.0%, an ORR of 30.77%, and a DCR of 89.74%, compared with 3.5 months, 74.6%, 18.18%, and 64.46% in the Gem-NabP group and 5.0 months, 82.6%, 16.36%, and 76.36% in the mFOLFIRINOX group, respectively (PFS, p < 0.001; ORR, p = 0.171; DCR, p = 0.007...