Supplementary file 1_Efficacy and toxicities of modified FOLFIRINOX versus gemcitabine plus nab-paclitaxel as first-line chemotherapy for unresectable pancreatic cancer: a systematic review and meta-analysis.docx

Compared with GnP, mFFX was associated with a shorter OS (HR 1.26, 95% CI 1.09–1.45; P = 0.002) and PFS (HR 1.21, 95% CI 1.04–1.40; P = 0.01), along with a borderline lower DCR (RR 0.90, 95% CI 0.81–1.00; P = 0.05; I² = 62%), which was consistent across RCTs (RR 0.88, 95% CI 0.81–0.94; I² = 0%) but not observed in retrospective studies (RR 0.96, 95% CI 0.71–1.29; I² = 87%), and ORR did not differ significantly between the two regimens.

As for toxicity profiles, mFFX showed an elevated incidence of grade ≥3 diarrhea (OR 5.63) and anorexia (OR 4.44). By contrast, grade ≥3 neutropenia (OR 0.66) and white blood cell decrease (OR 0.49) occurred more frequently under GnP.</p>Conclusions<p>GnP was associated with more favorable OS and PFS than mFFX, a borderline DCR advantage, and distinct toxicity profiles. Given the modest effect size and the limitations of this study, clinical decision-making should integrate patient age, performance status, and anticipated second-line therapy.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/, identifier CRD420251175959.</p>