Managing AEs Associated With the FOLFIRINOX and NALIRIFOX Regimens in Pancreatic Cancer
Panelists discuss how adverse event profiles differ between regimens—with FOLFIRINOX causing high rates of neutropenia and neuropathy while NALIRIFOX shows lower neuropathy rates but higher grade 3 diarrhea—making patient-specific factors crucial for treatment selection and emphasizing the importance of dose adjustments and patient education.
EP: 1.First-Line Treatment Options for Metastatic Pancreatic Adenocarcinoma
EP: 2.Insights From The NAPOLI-3 and PRODIGE4 Trials In Metastatic Pancreatic Adenocarcinoma
EP: 3.Managing AEs Associated With the FOLFIRINOX and NALIRIFOX Regimens in Pancreatic Cancer
EP: 4.NAPOLI-3 in Real World Practice: Expert Insights on Data From ASCO GI 2025
EP: 5.Evaluating the Impact Of UGT1A1*28 Status On Tolerability Of NALIRIFOX In mPDAC
EP: 6.NALIRIFOX In Practice: Treatment Strategies for Patients With mPDAC
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Dr. Shah discusses the adverse event profiles of the different first-line treatment regimens for metastatic pancreatic adenocarcinoma, highlighting how these profiles influence treatment selection. He notes that FOLFIRINOX is associated with high rates of neutropenia and neuropathy, while NALIRIFOX demonstrates lower rates of grade 3 neutropenia and neuropathy but higher rates of grade 3 diarrhea.
When selecting between these regimens, patient-specific factors become crucial in the decision-making process. For patients with concerns about neuropathy, NALIRIFOX may be preferable due to its lower oxaliplatin dose, resulting in less neuropathy. Similarly, for those at high risk of neutropenia, NALIRIFOX offers better management compared to FOLFIRINOX. However, clinicians must be proactive in addressing the increased risk of grade 3 or higher diarrhea associated with NALIRIFOX through aggressive anti-diarrheal management strategies.
Dr. Shah emphasizes the importance of dose adjustments in treating metastatic pancreatic cancer, which is primarily approached with palliative intent. The longer patients can remain on treatment with either regimen, the greater the benefit, making appropriate dose modifications essential. Patient education on self-monitoring and early reporting of adverse events also plays a critical role in effectively managing toxicities, ultimately improving treatment outcomes and quality of life for these patients.
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