FOLFIRINOX + gemcitabine

FOLFIRINOX + gemcitabine is a combination chemotherapy regimen that includes the multi-agent protocol FOLFIRINOX (composed of fluorouracil, leucovorin, irinotecan, and oxaliplatin) administered together with gemcitabine. Both regimens are antineoplastic agents used primarily in the treatment of pancreatic cancer. FOLFIRINOX acts by inhibiting DNA synthesis and function through multiple mechanisms—fluorouracil inhibits thymidylate synthase; irinotecan inhibits topoisomerase I; oxaliplatin forms DNA crosslinks; and leucovorin enhances fluorouracil’s activity. Gemcitabine is a nucleoside analog that also inhibits DNA synthesis by incorporating into DNA strands and causing chain termination. This combination targets rapidly dividing tumor cells via complementary cytotoxic mechanisms, aiming to maximize tumor cell kill in aggressive cancers such as pancreatic ductal adenocarcinoma[1][2][3][4].