Efficacy and safety of National Centralized Drug Procurement-procured versus non-National Centralized Drug Procurement oxaliplatin in unresectable or metastatic pancreatic cancer: a retrospective cohort study

Background: China's National Centralized Drug Procurement (NCDP) policy has substantially reduced the cost of essential medicines, yet concerns persist regarding the real-world therapeutic equivalence of NCDP-procured drugs compared to their non-NCDP counterparts. This study aimed to systematically evaluate, using real-world data, the comparative efficacy and safety of NCDP-procured versus non-NCDP oxaliplatin in patients with advanced pancreatic cancer. Methods: This single-center retrospective cohort study enrolled patients with unresectable or metastatic pancreatic cancer who received first-line mFOLFIRINOX between May 2022 and March 2025. Patients were stratified into NCDP and non-NCDP groups based on the procurement source of oxaliplatin. Primary endpoints were objective response rate (ORR) and progression-free survival (PFS). Safety was assessed by the incidence of adverse drug reactions (ADRs). Results: 15.4%, P=0.007), which remained significant after multivariable adjustment. After propensity score matching, baseline characteristics were well-balanced between groups (all P>0.10), and the primary findings remained consistent. The unit price of NCDP oxaliplatin (¥ 76/vial) was 45% of the price of the non-NCDP agent (¥ 170/vial), representing substantial cost savings. Conclusions: NCDP-procured oxaliplatin demonstrated comparable efficacy to non-NCDP alternatives in advanced pancreatic cancer, with a more favorable safety profile for specific hepatic and hematologic toxicities. These real-world findings support the translation of the national procurement policy into clinical practice, offering significant cost savings without compromising patient outcomes.