Background: FOLFIRINOX showed high efficacy but also high toxicity in metastatic pancreatic cancer (MPC). To reduce toxicity and maintain efficacy, many kinds of studies on modified FOLFIRINOX have been conducted. However, these studies do not have unified pattern of dose-modification. In addition to the diversity of 'planned dose' in study design for modified FOLFIRINOX, the 'actually administered dose' for patients are much more diverse in the real world studies. We aimed to visualize 10 year trend of ‘planned’ and ‘actual’ dose of FOLFIRINOX in prospective and retrospective trials and investigate clinical outcomes according to dose modification. Methods: A systematic literature search of databases (Medline, Embase, and Scopus) between 1 January 2011 and 30 September 2021 was conducted. Eligible studies included patients treated with FOLFIRINOX as first-line treatment in MPC and reported any type of information in ‘planned’ and ‘actual’ dose of FOLFIRINOX. For evidence mapping sorted by four groups (table 1), a web-based and interactive bubble-plot program (www.RDI-map.com) was developed. For clinical outcome assessment, data on objective response rate (ORR) and hematologic toxicity rate were pooled with random-effect model and compared according to planned dose of FOLFIRINOX. Results: A total of 37 studies were identified for evidence mapping. In the mapping, ‘planned’ dose of FOLFIRINOX ranged with 75–100% for oxaliplatin, 75-100% for irinotecan, 0–100% for 5-fluorouracil (5FU)-push, and 75–133% for 5FU-continuous intravenous injection (CIV), respectively. The ‘actual’ dose of each agents went down to 54–96%, 61–88%, 0–92%, and 63–98%, respectively. In the pooled analysis with 27 studies including clinical outcome, the overall ORR was 30.9% (95% CI, 27.4-34.4%). Comparing planned ‘standard’ FOLFIRINOX with planned ‘modified’ regimen, the ORR was 28.2% [95% CI, 22.5-33.9%] and 33.8% [95% CI, 30.3-37.3%], respectively (P = 0.100). Febrile neutropenia was 11.6% [95% CI, 0-16.0%] and 5.5% [95% CI, 0-8.9%], respectively in the same order (P = 0.030). Conclusions: The RDI-map.com effectively provided multifactorial evidence-mapping for the practical pattern of dose reduction in FOLFIRINOX, and it revealed a significant gap between ‘planned’ and ‘actual’ dose of FOLFIRINOX. Planned ‘modified’ FOLFIRINOX showed similar efficacy and reduced febrile neutropenia, compared to planned ‘standard’ regimen. This data can serve as a guidance in both prescribing FOLFIRINOX for clinicians and designing further studies for researchers in MPC.