Dr Lim on the Current Treatment Paradigm For Metastatic Pancreatic Cancer

Kian-Huat Lim, MD, PhD, medical oncologist, associate professor, medicine, Division of Medical Oncology, Siteman Cancer Center, the Washington University School of Medicine, discusses the current treatment options for patients with metastatic pancreatic cancer.

Despite advancements in oncology, systemic combination chemotherapy remains the primary treatment approach in both the first- and second-line pancreatic cancer settings, Lim says. Limited progress has been made regarding targeted therapies and immunotherapies for this disease, although promising data are emerging with KRAS inhibitors and certain immunotherapy combinations, which are still in early stages of study, according to Lim. For now, chemotherapy remains the cornerstone of treatment, with FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel (Abraxane) being the predominant regimens, he explains

A newer addition to the treatment armamentarium is NALIRIFOX (nanoliposomal irinotecan [Onivyde], 5-fluorouracil, leucovorin, and oxaliplatin), which has gained FDA approval and is now included in the National Comprehensive Cancer Network guidelines for pancreatic adenocarcinomaas an alternative first-line therapy for locally advanced or metastatic disease, Lim expands. NALIRIFOX closely resembles FOLFIRINOX in terms of efficacy and survival benefits but offers a distinct toxicity profile, he reports. Notably, NALIRIFOX is associated with more gastrointestinal adverse effects, such as diarrhea, but exhibits less neuropathy and bone marrow suppression compared with FOLFIRINOX, Lim elucidates, saying that these AE profile differences are crucial considerations for oncologists when selecting between the 2 regimens for individual patients.

The key distinction between NALIRIFOX and FOLFIRINOX lies in the replacement of free irinotecan with liposomal irinotecan in the NALIRIFOX regimen, he continues. Liposomal irinotecan has a prolonged tissue retention time, potentially resulting in sustained antitumor effects, according to Lim. Lim acknowledged that progress in developing novel therapies for metastatic pancreatic cancer has been slower compared with that in other malignancies. However, there is optimism for the future with the anticipation of more innovative treatment approaches on the horizon, he explains. Despite the current reliance on chemotherapy, ongoing research efforts, particularly in the realms of targeted therapies and immunotherapies, offer hope for improved outcomes and expanded treatment options for patients with metastatic pancreatic cancer in the coming years, Lim concludes.