| Summary: | Background: Metastatic pancreatic cancer is an aggressive malignancy with limited survival despite intensive chemotherapy. While modified FOLFIRINOX (mFOLFIRINOX) has illustrated efficacy, its real-world data are limited in low-resource healthcare systems. This study evaluated efficacy and toxicity and identified prognostic factors of mFOLFIRINOX as a first-line therapy for Vietnamese patients with metastatic pancreatic cancer. Methods: We conducted a retrospective cohort study of 36 patients receiving mFOLFIRINOX as first-line therapy. All patients received peg-filgrastim as the primary prophylaxis. An application of flexible treatment approach—interruption was permitted between cycles under physician guidance. Progression-free survival (PFS), overall survival (OS), tumor response, and adverse events were assessed. Prognostic factors were analyzed using log-rank tests and Cox regression models. Results: The median follow-up was 15.6 months (95% confidence interval [CI] 3.8-27.3). The overall response rate (ORR) was 30.6 %, and the disease control rate (DCR) was 66.6%. The median progression-free survival was 6.7 (95% CI 5.4-8) months, and the median overall survival was 12.5 (95% CI 9.5-15.4) months. Grade 3 or 4 toxicities were mainly hematologic, including neutropenia in 33.4%, and anemia in 5.6% of patients. No cases of febrile neutropenia were observed. Univariate analyses identified performance status (PS) and age under 60 years as associated with improved outcomes. In multivariate Cox regression, PS remained an independent prognostic factor for overall survival. Conclusion: mFOLFIRINOX regimen demonstrated efficacy and manageable toxicity in Vietnamese patients with metastatic pancreatic cancer. An individualized approach involving treatment interruptions was observed in patients with relatively favorable outcomes. These findings support the feasibility of the regimen in real-world settings.
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