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Opinion|Videos|June 17, 2026

Triplet vs. Doublet Therapy: Navigating Clinical Nuances and Long-Term Survival Data

Author(s)Daniel H. Ahn, DO, Midhun Malla, MD

Choosing between triplet and doublet regimens requires careful individualization based on performance status, comorbidities, and disease burden. This segment examines the clinical factors guiding selection between NALIRIFOX and FOLFIRINOX, including peripheral neuropathy risk, GI tolerability, and the role of genomic mutations in sensitizing tumors to platinum-based or DNA-damaging agents.

Episodes in this series

EP. 1 First-Line Treatment Decisions in Metastatic Pancreatic Cancer: Setting the Stage

EP. 1 First-Line Treatment Decisions in Metastatic Pancreatic Cancer: Setting the Stage

EP. 2 Triplet vs. Doublet Therapy: Navigating Clinical Nuances and Long-Term Survival Data

EP. 2 Triplet vs. Doublet Therapy: Navigating Clinical Nuances and Long-Term Survival Data

Choosing between triplet and doublet regimens requires careful individualization based on performance status, comorbidities, and disease burden. This segment examines the clinical factors guiding selection between NALIRIFOX and FOLFIRINOX, including peripheral neuropathy risk, GI tolerability, and the role of genomic mutations in sensitizing tumors to platinum-based or DNA-damaging agents. The discussion turns to the NAPOLI 3 trial, which established NALIRIFOX as a validated first-line standard of care, and updated long-term survival data highlighting extreme responders with greater than 18-month overall survival. A key insight emerges: prolonged drug exposure and dose modification rather than dose intensity drive durable disease control, even in patients with adverse features such as extensive liver metastases. A compelling real-world case of a three-year survivor on NALIRIFOX brings the data powerfully to life.

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