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Comparison of Frontline FOLFIRINOX with Fluorouracil-Based and Gemcitabine-Based Chemotherapies in Metastatic

Ali Kalem1, Tulay Kus1, Savas Gokcek2

  • 1Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep 27310, Turkey.

Journal of Clinical Medicine
|August 28, 2025
PubMed
Summary
This summary is machine-generated.

Frontline FOLFIRINOX chemotherapy for advanced ampullary adenocarcinoma showed a trend toward improved survival in the intestinal subtype, despite increased toxicity. Outcomes were similar to other regimens in the pancreaticobiliary subtype.

Keywords:
FOLFIRINOXampullary tumorsgemcitabine-basedintestinal subtypemetastaticpancreaticobiliary subtype

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Area of Science:

  • Oncology
  • Gastroenterology
  • Clinical Therapeutics

Background:

  • Ampullary adenocarcinoma is a rare cancer with limited data on effective first-line treatments for metastatic disease.
  • Investigating the efficacy of FOLFIRINOX as a frontline therapy compared to other chemotherapy regimens is crucial for advanced cases.

Purpose of the Study:

  • To compare the outcomes of first-line FOLFIRINOX chemotherapy with other treatments in patients with advanced ampullary adenocarcinoma.
  • To evaluate the impact of different chemotherapy regimens on progression-free survival and overall survival based on histological subtypes.

Main Methods:

  • Retrospective study of 123 patients with advanced ampullary adenocarcinoma treated with frontline FOLFIRINOX, fluorouracil (FU)-based, or gemcitabine-based chemotherapy.
  • Analysis of median progression-free survival (mPFS) and overall survival (mOS) using the Kaplan-Meier method.
  • Comparison of outcomes based on treatment regimens and clinicopathological features, including histological subtypes.

Main Results:

  • No significant difference in overall survival (OS) was observed among the different chemotherapy agents across all histological subtypes.
  • FOLFIRINOX and FU-based treatments showed greater efficacy in the intestinal subtype, while gemcitabine-based therapies were less effective.
  • FU-based therapies resulted in shorter outcomes in the pancreaticobiliary subtype compared to FOLFIRINOX and gemcitabine-based therapies.
  • Higher rates of grade 3 or 4 hematologic toxicities were noted in patients receiving FOLFIRINOX.

Conclusions:

  • Frontline FOLFIRINOX demonstrated a trend toward improved OS in the intestinal subtype of advanced ampullary adenocarcinoma, despite increased toxicity.
  • FOLFIRINOX provided similar outcomes to other regimens in the pancreaticobiliary subtype.
  • Chemotherapy selection may be influenced by histological subtype in advanced ampullary adenocarcinoma.