S18 Ep39: Pancreatic Cancer Experts Map Treatment Sequencing With Liposomal Irinotecan and Beyond

Pancreatic cancer treatment is shifting toward more targeted, mutation-specific strategies and refined chemotherapy regimens. The NAPOLI-3 trial demonstrates that the NaliriFox regimen—liposomal irinotecan, oxaliplatin, and 5-FU—significantly improves overall survival compared to gemcitabine and nab-paclitaxel, while offering a more favorable toxicity profile regarding grade 3 neuropathy. The emergence of pan-RAS inhibitors, such as adagrasib, provides a critical second-line option for patients with metastatic disease, showing a clear survival benefit over standard chemotherapy. Future advancements focus on integrating these inhibitors into frontline settings and addressing tumor heterogeneity through multi-antigen CAR-T therapies and combination trials targeting specific KRAS mutations like G12D and G12V. Oncologists Raji Shameem and Shubham Pant emphasize that while chemotherapy remains the frontline standard, the evolving landscape increasingly relies on patient-specific factors and molecular profiling to optimize therapeutic outcomes.