The value of FOLFIRINOX in advanced pancreatic cancer: balancing efficacy, toxicity, and quality of life

Whilst FOLFIRINOX achieves high initial disease control in advanced PDAC, its benefit is limited by substantial toxicity and poor durability. Only a minority of patients maintain disease control beyond 6 months, which is strongly associated with improved survival. These findings suggest a need to redefine 'valuable FOLFIRINOX chemotherapy' to encompass not only initial response but also sustained disease control, toxicity management, and shared decision-making to optimise the benefit of FOLFIRINOX for patients.