Videos

1 expert is featured in this series.

A panelist discusses how this is an exciting time for pancreatic cancer treatment with the development of RAS inhibitors targeting KRAS mutations (present in approximately 90% of patients with metastatic pancreatic cancer, including G12D, G12V, and G12C variants), which have shown impressive response rates in later-line settings and are being evaluated in frontline trials, before concluding the Targeted Oncology discussion on the metastatic pancreatic adenocarcinoma treatment landscape.

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Panelist discusses how NALIRIFOX (liposomal irinotecan, 5-fluorouracil, leucovorin, oxaliplatin) represents a reasonable treatment option for patients with excellent performance status and locally advanced pancreatic adenocarcinoma, requiring close monitoring and proactive toxicity management to maximize outcomes.

1 expert in this video

Panelist discusses how post hoc analyses of the NAPOLI-3 trial revealed that dose reductions for toxicity management do not adversely affect overall survival and that UGT1A1 mutations do not significantly impact treatment tolerability with nanoliposomal irinotecan.

1 expert is featured in this series.

A panelist discusses how proactive adverse event management is crucial for patients with metastatic pancreatic cancer, including using every-2-week scheduling and primary granulocyte colony-stimulating factor (G-CSF) support to reduce myelosuppression, providing extensive patient counseling about diet, hydration, and early antidiarrheal use for liposomal irinotecan-related diarrhea, and closely monitoring for cumulative neuropathy with consideration of oxaliplatin discontinuation by 3 to 4 months if responding to prevent limitations on future therapy options.

1 expert is featured in this series.

A panelist discusses how treating metastatic pancreatic cancer requires a multidisciplinary approach with early palliative care and dietitian involvement, emphasizing that for patients with good performance status, 3-drug regimens like NALIRIFOX or modified FOLFIRINOX can provide clinical responses and quality-of-life improvements even in high disease burden cases, whereas frail patients benefit from gemcitabine plus nab-paclitaxel administered every 2 weeks, and notes that age alone should not exclude patients from 3-drug regimens as the NAPOLI-3 trial included patients aged up to 85 years.

1 expert in this video

Panelist discusses how NALIRIFOX (liposomal irinotecan, 5-fluorouracil [5-FU], leucovorin, oxaliplatin) management requires careful attention to cytopenia prevention through growth factor use and aggressive diarrhea management with patient education and antidiarrheal medications.

1 expert in this video

Panelist discusses how the development of nanoliposomal irinotecan led to the NAPOLI-1 trial showing a survival benefit in second-line treatment and subsequently the NAPOLI-3 trial demonstrating the superiority of NALIRIFOX (liposomal irinotecan, 5-fluorouracil [5-FU], leucovorin, oxaliplatin) over gemcitabine/nab-paclitaxel in first-line metastatic disease.

1 expert is featured in this series.

Overview of Clinical Trial Data A panelist discusses how first-line treatment recommendations are based on 3 pivotal phase 3 randomized trials: PRODIGE 4 (which established FOLFIRINOX superiority over gemcitabine with 11.1 vs 6.8 months overall survival despite higher toxicity), MPACT (showing gemcitabine plus nab-paclitaxel benefit over single-agent gemcitabine with 8.5 vs 6.7 months survival), and the recent NAPOLI-3 (demonstrating NALIRIFOX superiority over gemcitabine plus nab-paclitaxel with 11.1 vs 9.2 months overall survival in over 750 patients across 180 sites).

1 expert is featured in this series.

A panelist discusses how treatment selection for metastatic pancreatic adenocarcinoma involves evaluating multiple factors including genetic and somatic mutations (particularly homologous recombination deficiency [HRD] alterations like BRCA1/2 and PALB2, which favor platinum-based regimens), patient age and performance status, liver function status, and drug metabolism genotype testing such as dihydropyrimidine dehydrogenase (DPD) deficiency screening to avoid severe 5-FU toxicity in rare cases of homozygous variants.