Real-world comparative effectiveness of FOLFIRINOX versus gemcitabine/nab-paclitaxel in metastatic pancreatic cancer: prognostic impact of metastatic site and burden in a Middle Eastern cohort

Background: Pancreatic cancer (PC) is one of the most aggressive cancers, with low survival rates. Although FOLFIRINOX (FFX) and gemcitabine plus nab-paclitaxel (GnP) are standard first-line treatments, there is a lack of comparative real-world data from Middle Eastern populations, as well as the prognostic significance of metastatic patterns. The study aims to examine the efficacy and toxicity of FFX and GnP in advanced and metastatic PC, as well as assess how the site and number of metastases affect survival outcomes. Methods: This retrospective cohort analysis comprised 60 patients with advanced or metastatic PC treated at a tertiary center from 2019 to 2024. Patients were given either FFX (n=36) or GnP (n=24). The baseline clinicopathologic data, treatment response, toxicity, and survival outcomes were evaluated with SPSS v29. Survival was assessed using Kaplan-Meier and compared using the log-rank test. Variables with P