FFX (or mFFX) vs NALIRIFOX: Managing Toxicity and Genetic (UGT1A1*28) Dose Considerations in mPDAC

Video content above is prompted by the following:

The ASCO 2025 NAPOLI-3 update revealed important insights about long-term survivors in metastatic pancreatic cancer, identifying approximately 20 patients who achieved exceptional outcomes with median overall survival reaching 18 to 19 months compared with the overall study population’s 11.1 months. These long-term responders were characterized by younger age, better performance status, and lower CA 19-9 levels, suggesting reduced disease burden at treatment initiation. This subset analysis reinforces the importance of early intervention and optimal patient selection for aggressive treatment approaches.

The long-term survivor analysis supports the clinical practice of dose modifications and treatment continuation strategies, with data showing that patients who remained on therapy longer through dose adjustments achieved superior outcomes. This finding validates the “marathon, not sprint” approach to pancreatic cancer treatment, emphasizing sustained treatment delivery over maximum initial intensity. The ASCO Gastrointestinal Cancers Symposium presentation reinforced that maintaining patients on treatment through careful dose modifications and schedule adjustments can significantly impact survival outcomes.

These updated analyses provide crucial real-world guidance for practicing oncologists, demonstrating that both liposomal irinotecan and oxaliplatin dose modifications allow continued treatment without compromising efficacy. The data support patient counseling that dose reductions, when medically indicated, may actually improve long-term outcomes by enabling sustained treatment delivery. This evidence-based approach helps address patient concerns about dose modifications while optimizing treatment duration and overall survival benefits.