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This sequential neoadjuvant chemotherapy regimen consists of an initial phase of nab-paclitaxel plus gemcitabine (the AG regimen) followed by a phase of modified FOLFIRINOX (mFOLFIRINOX). It is being evaluated by the Second Affiliated Hospital, School of Medicine, Zhejiang University in a Phase 3 clinical trial (NCT03750669) for patients with resectable pancreatic ductal adenocarcinoma. The AG regimen involves nab-paclitaxel, a microtubule inhibitor, and gemcitabine, a nucleoside analog. mFOLFIRINOX is a combination of 5-fluorouracil (antimetabolite), leucovorin (folate analogue), irinotecan (topoisomerase I inhibitor), and oxaliplatin (platinum-based antineoplastic). The sequential approach aims to delay drug resistance and improve surgical outcomes compared to upfront surgery by utilizing multiple cytotoxic mechanisms to target cancer cell division and DNA replication.
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