Paul E. Oberstein, MD; Priyadarshini Pathak, MBBS, and Tara E. Seery, MD discuss how to optimize treatment decisions for pancreatic cancer patients by comparing NALIRIFOX versus modified FOLFIRINOX regimens, sequencing therapies from first to second line, managing toxicities through dose modifications to maintain patients on treatment longer, and the promising pipeline of emerging targeted therapies including KRAS inhibitors and immunotherapy combinations presented at ASCO 2025.