Observational studyThe oncologist2026
Second-line chemotherapy after gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer: comparative outcomes and AI-guided treatment selection.
Observational study in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Second-Line Systemic Therapy Following First-Line FOLFIRINOX or NALIRIFOX in Metastatic Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis.Journal of gastrointestinal cancer · 2026Pooled it
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
32 authors.
Funding
Abstract
backgroundInternational guidelines recommend 5FU/LV, Nal-IRI + 5FU/LV, FOLFIRI, FOLFOX, or (m)FOLFIRINOX as second-line (2L) chemotherapy for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) after failure of gemcitabine+Nab-paclitaxel (GnP). However, a head-to-head comparison has not been performed. PATIENTS AND
methodsWe conducted an observational cohort study of consecutive mPDAC patients treated with 2L chemotherapy after GnP failure at 41 Italian centers. Progression-free survival (PFS) and overall survival (OS) were compared using inverse probability of treatment weighting. Interpretable artificial intelligence methods were applied to optimize treatment allocation. A counterfactual Cox model was trained on baseline characteristics to estimate 12-month PFS under each regimen, and an Optimal Policy Tree (OPT) was derived to generate treatment recommendations, validated in a test set. Net-benefit curves evaluated clinical utility.
resultsAmong 704 eligible patients, 56 (8.0%) received 5FU/LV, 153 (21.7%) FOLFIRI, 209 (29.7%) FOLFOX, 209 (29.7%) Nal-IRI + 5FU/LV, and 77 (10.9%) FOLFIRINOX. FOLFIRINOX was associated with the longest PFS and OS. Median PFS was comparable among doublets (3.5 months FOLFOX, 3.6 FOLFIRI, 3.3 Nal-IRI + 5FU/LV), though Nal-IRI + 5FU/LV showed a long-term benefit. The OPT recommended Nal-IRI + 5FU/LV for patients with head/body tumors, Eastern Cooperative Oncology Group performance status (PS) 0, or CA19.9 < 109 U/mL in those with PS > 0. Net-benefit analysis showed that the OPT consistently outperformed uniform treatment strategies, achieving a 2.5 percentage-point net benefit at a threshold probability of ∼9%.
conclusionsFOLFIRINOX appears the most effective option for carefully selected, fit patients eligible for 2L chemotherapy after GnP failure. Interpretable artificial intelligence-derived treatment policies may provide superior net clinical benefit compared to uniform approaches and guide individualized therapy, warranting integration with upcoming targeted strategies such as RAS inhibitors.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.