Enhanced Survival Outcomes with FOLFIRINOX in Initial Metastatic Pancreatic Cancer: Single-Center Study

Introduction. The aim of this article is to evaluate the efficacy and outcomes of FOLFIRINOX as a first-line treatment for initial metastatic pancreatic cancer patients at the Clinical Center University of Sarajevo. Methods. The research presents a retrospective analysis was conducted on 33 patients treated with FOLFIRINOX, between January 2021 and January 2023. Baseline characteristics, tumor markers (CEA, CA 19-9, CA 125), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR) and initial metastatic site were evaluated using Cox regression analysis in order to identify predictive and prognostic factors for progression-free survival (PFS) and overall survival (OS). Results. The median age of patients was 64 (range 38-76). There were 18 males and 15 females. The median OS was 21.7 months (95% CI, 10.5-32.9) and the median PFS was 10.0 months (95% CI, 8.2-11.8). A statistically significant negative correlation was found between NLR and OS (r=-0.464, p=0.045). Patients with initial liver metastasis had a numerically worse median OS (16.3 months, 95% CI, 5.1-27.5), compared to those with non-liver metastasis (OS not reached, p=0.058). Tumor markers, NLR, NPR, and initial metastatic site were not independent predictors of PFS and OS. Conclusion. FOLFIRINOX demonstrates significant efficacy in treating metastatic pancreatic cancer in a real-world setting. Personalized approaches, including genetic profiling and microbiome analysis, along with AI integration, offer promising avenues to enhance treatment outcomes and quality of life for patients. Keywords: metastatic pancreatic cancer, enhanced outcomes, overall survival, progression-free survival.