S93 Neoadjuvant FOLFIRINOX vs Gemcitabine Plus Paclitaxel for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis of Surgical and Pathological Outcomes

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 vs 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: Fifteen 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 2 regimens (P = 0.7132). The OR for pathological complete response was 1.44 (95% CI: 0.76–2.74; I2 = 3.9%), showing similar odds between the 2 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%]. Conclusion: 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.