The study is focused on comparing two chemotherapy regimens, SOXIRI and mFOLFIRINOX, for patients with advanced pancreatic cancer. mFOLFIRINOX is currently the go-to first-line treatment and is a cocktail of four different chemotherapy drugs: fluorouracil, leucovorin, irinotecan, and oxaliplatin. SOXIRI is an alternative regimen that has recently come into the picture and consists of S-1, oxaliplatin, and irinotecan.

Methodology: How Was the Study Conducted?

The study was conducted retrospectively, meaning it looked back at existing medical records. The researchers reviewed cases from Sun Yat-sen University Cancer Centre between July 2012 and June 2021. Key criteria for inclusion in the study were whether the patient had locally advanced or metastatic pancreatic cancer and had been treated with either SOXIRI or mFOLFIRINOX.

Outcomes studied included:

• Overall survival (OS): How long patients lived after beginning treatment.
• Progression-free survival (PFS): How long patients lived without their disease worsening.
• Objective response rate: How many patients showed a reduction in tumor size.
• Disease control rate: How many patients experienced either a reduction in tumor size or stability in their condition.
• Safety: Frequency and severity of side effects.

Results: What Did They Find?

In total, 198 patients were part of the study. Of these, 102 received SOXIRI and 96 received mFOLFIRINOX.

• Overall Survival (OS) & Progression-Free Survival (PFS): No significant difference was noted between the two treatment groups. The OS was 12.1 months for SOXIRI and 11.2 months for mFOLFIRINOX (p=0.81), while the PFS was 6.5 months and 6.8 months, respectively (p=0.96).

• Subgroup Analysis: Patients with slightly higher baseline levels of total bilirubin (TBIL) or those who were underweight before chemotherapy tended to do better with SOXIRI compared to mFOLFIRINOX.

• Efficacy Predictor: A decline in the levels of the carbohydrate antigen (CA) 19-9 was identified as a good predictor for the effectiveness of both treatments.

• Safety: The side effects were generally similar, except anaemia was more common in the SOXIRI group (41.4% vs 24%, p=0.03).

Conclusions: What Does This Mean for Patients and Clinicians?

The SOXIRI regimen is more or less on par with mFOLFIRINOX in terms of efficacy and safety for treating advanced pancreatic cancer. In certain subgroups of patients, SOXIRI might even offer slight advantages. It also holds its own in terms of safety, with the caveat that it may be more likely to cause anaemia.

Why This Matters

Understanding the relative strengths and weaknesses of these two regimens can aid doctors in personalizing treatment plans for patients. For those who may be more susceptible to the side effects of mFOLFIRINOX, or who fall into the subgroups where SOXIRI seems more effective, this alternative could be a game-changer.

In summary, the study suggests that SOXIRI is a worthy competitor to mFOLFIRINOX in treating advanced pancreatic cancer and offers clinicians an additional tool in their therapeutic arsenal.