NALIRIFOX In Practice: Treatment Strategies for Patients With mPDAC
Panelists discuss how dose reductions in the NAPOLI-3 trial paradoxically led to improved survival outcomes (12.6 months for nanoliposomal irinotecan reductions and 13.5 months for oxaliplatin reductions versus shorter survival with full doses), supporting their clinical approach of maintaining patients on tolerable doses for longer treatment duration rather than pursuing maximum dose intensity.
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. Chandana reviews a post-hoc analysis of the NAPOLI-3 trial presented at ASCO GI 2025, which examined the impact of dose reductions on treatment outcomes. The analysis compared patients who maintained full doses throughout treatment with those who required at least one dose reduction of either oxaliplatin or nanoliposomal irinotecan. Interestingly, patients who underwent dose reductions actually received more total chemotherapy and demonstrated improved survival outcomes.
Specific survival differences were notable across treatment groups. Patients who had nanoliposomal irinotecan dose reductions achieved a median overall survival of 12.6 months compared to 9.4 months for those maintained on full doses. Similarly, with oxaliplatin dose reductions, survival was 13.5 months versus 7.7 months for the full-dose group. These findings align with Dr. Chandana's clinical experience, where he typically initiates treatment at full dose but maintains a low threshold for dose reductions when patients experience side effects such as nausea, vomiting, or diarrhea.
Both Dr. Chandana and Dr. Shah follow similar approaches in their practices—starting patients on full doses and then promptly implementing dose reductions when necessary, especially once a treatment response is confirmed. This strategy prioritizes quality of life and prolonged treatment duration over maximum dose intensity. The session concludes with both physicians emphasizing that maintaining patients on treatment longer at tolerable doses may be more beneficial than persisting with full doses that cause significant toxicities, ultimately resulting in better survival outcomes and improved quality of life.
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