P0086 - Neoadjuvant FOLFIRINOX Versus Gemcitabine Plus Paclitaxel for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis of Surgical and Pathological Outcomes

Ahmed Raza, ¹, Wardah Ali, ², Muhammad Ansab, ¹, Rahman Tanveer, ³, Muhammad Saffi Ullah, MBBS⁴, Zain Sadiq, MBBS⁴, Ayesha Younas, MBBS⁵, Rahmah Muhammad, ², Faiza Fatima, MBBS¹, Faryal Altaf, MD⁶, Zaheer Qureshi, MD⁷
1Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 2Jinnah Sindh Medical University, Karachi, Sindh, Pakistan; 3Punjab Medical College, Faisalabad, Punjab, Pakistan; 4Quaid-e-Azam Medical College, Bahawalpur, Punjab, Pakistan; 5Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 6BronxCare Health System, Bronx, NY; 7The Frank H. Netter M.D. School of Medicine at Quinnipiac University, Bridgeport, CT

Introduction: Patients with borderline resectable or locally advanced pancreatic cancer have tumors that are difficult to remove completely. Neoadjuvant chemotherapy shrinks the tumor and improves the chances of successful surgery. Two common chemotherapy regimens are FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel (GNP). We aim to find which regimen leads to better surgical outcomes and tumor responses.

Methods: A systematic search was conducted across PubMed, Cochrane Central, Embase, Scopus, and Clinicaltrials.gov from inception till February 2025. Fifteen studies evaluating the efficacy of neoadjuvant FOLFIRINOX versus GNP were included. The data were extracted for resection margins status and pathological responses, and the analysis was performed on RStudio v4.4.5, meta package v8.0.2. The Mantel-Haenszel model was used to pool the studies, and between-study variance was assessed through Der-Simonian Laird using I² statistics. The pooled outcome estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: 15 studies comprising 2,446 patients were included in the analysis. 1,613 surgically resectable patients from 14 studies after surgery were assessed for margin positivity status. The OR for R0 resection (negative resection margin) was 0.95 (95% CI: 0.73 – 1.24; I² = 0%), indicating no difference for R0 resection rates between the two regimens (p = 0.7132). The OR for pathological complete response (pCR) was 1.44 (95% CI: 0.76 – 2.74; I² = 3.9%), showing similar odds between the two interventions (p = 0.2607). Similarly, for pathological major response [OR: 1.38 (95% CI: 0.64 – 2.96); p = 0.4063; I² = 0%] and pathological limited response [OR: 1.11 (95% CI: 0.83 – 1.48); p = 0.4992; I² = 0%], which showed no significant differences between the interventions. However, pathological moderate response was significantly higher in the GNP group [OR: 0.70 (95% CI: 0.53 – 0.92); p = 0.0109; I² = 0%].

Discussion: Overall, neoadjuvant FOLFIRINOX and GNP yield comparable R0 resection rates and similar odds of complete, major, and limited pathological responses. However, GNP is associated with a significantly higher odds of moderate pathological response.


Figure: Forest Plot for R0 Resection Rate in Patients Receiving Neoadjuvant FOLFIRINOX vs. GNP for Borderline Resectable or Locally Advanced Pancreatic Cancer


Figure: Forest Plot for Pathological Complete Response in Patients Receiving Neoadjuvant FOLFIRINOX vs. GNP for Borderline Resectable or Locally Advanced Pancreatic Cancer

Disclosures:
Ahmed Raza indicated no relevant financial relationships.
Wardah Ali indicated no relevant financial relationships.
Muhammad Ansab indicated no relevant financial relationships.
Rahman Tanveer indicated no relevant financial relationships.
Muhammad Saffi Ullah indicated no relevant financial relationships.
Zain Sadiq indicated no relevant financial relationships.
Ayesha Younas indicated no relevant financial relationships.
Rahmah Muhammad indicated no relevant financial relationships.
Faiza Fatima indicated no relevant financial relationships.
Faryal Altaf indicated no relevant financial relationships.
Zaheer Qureshi indicated no relevant financial relationships.

Ahmed Raza, ¹, Wardah Ali, ², Muhammad Ansab, ¹, Rahman Tanveer, ³, Muhammad Saffi Ullah, MBBS⁴, Zain Sadiq, MBBS⁴, Ayesha Younas, MBBS⁵, Rahmah Muhammad, ², Faiza Fatima, MBBS¹, Faryal Altaf, MD⁶, Zaheer Qureshi, MD⁷. P0086 - Neoadjuvant FOLFIRINOX Versus Gemcitabine Plus Paclitaxel for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis of Surgical and Pathological Outcomes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.