Balancing Real-World Evidence and Clinical Trial Data in Regimen Selection

Translating clinical trial findings into everyday oncology practice requires nuanced judgment. This segment discusses how real-world evidence and systematic meta-analyses of the three major phase III frontline trials inform regimen selection between NALIRIFOX, FOLFIRINOX, and gemcitabine/nab-paclitaxel. While the meta-analysis confirms that triplet therapy yields superior overall survival outcomes compared to doublet regimens, the absence of head-to-head prospective data between the two triplets means the decision remains inherently patient-driven. Institutional practices have evolved to increasingly incorporate NALIRIFOX alongside modified FOLFIRINOX, while performance status, comorbidities, response urgency, and patient preferences remain the ultimate arbiters. The segment closes with a case presentation of a 67-year-old male with de novo metastatic disease, a KRAS G12D mutation, and limited social support, setting up a rich clinical decision-making discussion.