Abstract #LBA661: Zev A. Wainberg presented results of the P3 NAPOLI-3 trial comparing liposomal irinotecan + 5-fluorouracil/leucovorin + oxaliplatin (NALIRIFOX) vsnab-paclitaxel + gemcitabine (Gem+NabP) in 770 treatment-naïve pts with mPDAC

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Results:

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Thought leader reactions were mixed. Some were excited that the trial met its primary endpoint of improved survival in treatment-naïve mPDAC.

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A few oncologists declared NALIRIFOX “a” new standard of care – but not “the” new standard of care in this patient population.

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Many commentators viewed NALIRIFOX as superior to Gem+NabP but not to FOLFIRINOX –and felt that the results did not represent an advance for pancreatic cancer.

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Several raised concerns around cost and access to liposomal irinotecan – and believed that NALIRIFOX would not be cost-effective compared to FOLFIRINOX.

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Others bemoaned the lack of QoL data and felt that QoL was more important than survival for a terminal disease, particularly for older patients.

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Summary:

‍While NAPOLI-3 met its primary endpoint of improved survival in treatment-naïve mPDAC, and could present another option for patients, thought leaders remain skeptical of NALIRIFOX as the new standard of care in this population. NALIRIFOX will likely be considerably more expensive than FOLFIRINOX (FFX) and confers a similar survival benefit, leaving many to wonder why they would choose this new regimen over FFX. Some oncologists also felt that the lack of quality-of-life data represented a significant gap in the case for NALIRIFOX.

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