The TCOG T5217 trial compared two intensive chemotherapy regimens for advanced pancreatic cancer: mFOLFIRINOX, a modified global standard, and SLOG, an Asian-specific combination of S-1, leucovorin, oxaliplatin, and gemcitabine. Both treatments provided similar survival benefits, with median overall survival of 12.1 months for mFOLFIRINOX and 12.9 months for SLOG, and comparable progression-free survival and response rates.
Side effects differed between the two regimens. mFOLFIRINOX caused more hematologic issues, including neutropenia in over half of patients, while nearly 30% needed growth factor support. SLOG led to more gastrointestinal and skin effects, such as oral mucositis and skin hyperpigmentation, but caused less fatigue and anorexia.
The trial also explored the role of Homologous Recombination Deficiency (HRD) as a biomarker. About 13% of patients had HRD-related mutations, and those patients had longer survival (17.7 months vs. 11.7 months). The study shows SLOG is an effective, potentially more tolerable first-line option for Asian patients and highlights how genetic profiling could guide personalized chemotherapy choices.