FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer

To the Editor: Conroy et al. (May 12 issue) 1 report that FOLFIRINOX (a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin) provided a statistically and clinically significant benefit over single-agent gemcitabine in patients with advanced pancreatic cancer. Although the increased toxicity associated with this combination therapy may temper enthusiasm, this is the first real advance in such therapy since the introduction of gemcitabine. It has been debated whether gemcitabine-based combination therapies provide any additional benefit, and meta-analyses have reached conflicting conclusions. 2 – 4 A sensitivity analysis of data pooled from seven randomized trials involving 2422 patients in which single-agent . . .