Priyadarshini Pathak, MBBS

Drs Seery, Oberstein, and Pathak discuss data from the NAPOLI 3 trial of NALIRIFOX vs nab-paclitaxel and gemcitabine in treatment-naive pancreatic cancer.

Panelists discuss how promising developments at ASCO 2025 include novel immunotherapy combinations, KRAS G12D-targeted therapies in phase 3 trials, tumor treating fields for locally advanced disease, and the importance of addressing nutrition and quality of life alongside pharmacologic advances.

Panelists discuss how the NAPOLI-1 trial established 5-FU/leucovorin plus liposomal irinotecan as the standard second-line therapy for patients who received gemcitabine-based first-line treatment, though patient selection remains challenging.

Panelists discuss how second-line therapy sequencing involves using the backbone not received in first-line (5-FU or gemcitabine-based), with increased emphasis on quality of life discussions and the importance of early tumor sequencing for potential targeted therapies.

Panelists discuss how real-world data suggest similar efficacy between NALIRIFOX and FOLFIRINOX, and how sequential therapy approaches using doublets don’t appear superior to up-front triplet regimens for appropriate patients.

Panelists discuss how NALIRIFOX differs from modified FOLFIRINOX primarily in lower neuropathy rates due to reduced oxaliplatin dosing, higher diarrhea rates, and lower neutropenia, while UGT1A1 testing is generally not required up front.

Panelists discuss how recent ASCO data showed long-term responders on NALIRIFOX were younger, fitter patients with lower disease burden who could tolerate treatment longer, reinforcing the strategy of dose modifications to maintain patients on therapy.

Panelists discuss how the PRODIGE-4 and NAPOLI-3 trials differed in patient populations, age limits, and comparator arms, leading to similar regimens with dosage modifications that have become standard practice.

Panelists discuss how patient choice and long-term toxicity considerations, particularly neuropathy differences between NALIRIFOX and FOLFIRINOX, influence treatment decisions while managing patient expectations about stable disease being a positive outcome.

Panelists discuss how the evolution of pancreatic cancer treatment has progressed since 2011 with key trials like PRODIGE-4 (FOLFIRINOX) and NAPOLI-3 (NALIRIFOX), and how clinicians choose between regimens based on patient characteristics and adverse effect profiles.

Panelists discuss how treatment decisions for locally advanced pancreatic cancer should consider systemic therapy followed by radiation, with triplet regimens preferred for younger patients with good performance status, while acknowledging the limited evidence base requiring extrapolation from metastatic data.

Panelists discuss how to approach a 55-year-old woman with locally advanced pancreatic cancer involving portal vein invasion, emphasizing the importance of staging, performance status assessment, and systemic chemotherapy as first-line treatment.