Background:Advanced pancreatic cancer (APC) is a highly lethal malignancy which has one of the worsttreatment outcomes. Modified (m)FOLFIRINOX is an intense but a proven treatment approach with asurvival benefit for APC. Although mFOLFIRINOX demonstrated survival benefit compared with gemci-tabine monotherapy, the standard treatment in previous years, toxicity is a difficult aspect of thistreatment.Methods:A retrospective analysis of patients referred to Medical Oncology Clinics of Ankara OncologyResearch and Training Hospital with the diagnosis of inoperable locally advanced or metastaticpancreatic cancer and treated with mFOLFIRINOX or gemcitabine monotheraphy from March 2013 toApril 2018 was performed.Results:Forty three patients and 37 patients were included in mFOLFIRINOX and gemcitabine groups,respectively. The mean age of the patients was 53.74 years (range: 32e69) and 65,7 years (range: 47e82)for mFOLFIRINOX and gemcitabine, respectively (95% CI, p<0.001). All patients, except one, had ECOGperformance status of 0 or 1 in mFOLFIRINOX group. In contrast, nine patients had ECOG performancestatus of 2 in the gemcitabine group (95% CI, p¼0.002). When the patients were evaluated for response,11 (25.6%) and 6 (16.2%) had partial remission with mFOLFIRINOX and gemcitabine, respectively. MedianPFS and OS was 5,73 (95% CI, 2,57-8,90) months and 8.77 (95% CI, 6.54e10.99) months with mFOLFIR-INOX and 2,77 (95% CI, 2,29-3,24) months and 5.80 (95% CI, 3.08e7.92) months with gemcitabine,respectively. mFOLFIRINOX regimen was more toxic than gemcitabine regimen. The incidences of all-grade neutropenia, neuropathy, and emesis were more prominent in the mFOLFIRINOX group.Conclusion:mFOLFIRINOX is a difficult regimen for both patients and physicians with significant toxicitywith a greater survival benefit. The survival benefit was modest in this real-life experience. Patient se-lection bias and small sample size of this retrospective study should be considered.