Importance of NAPOLI 3 in Pancreatic Cancer for Community Oncologists

Zev A. Wainberg, MD, a professor of medicine at University of California, Los Angeles (UCLA), and co-director of the UCLA Gastrointestinal Oncology Program, discusses the pressing relevance of the outcomes of NAPOLI 3 (NCT04083235), which were presented at the 2023 Gastrointestinal Cancers Symposium.

The phase 3 study found the combination of irinotecan liposome injection (Onivyde), 5-fluorouracil (5-FU), oxaliplatin, and leucovorin (NALIRIFOX) was superior in progression-free survival and overall survival compared with gemcitabine plus nab-paclitaxel in patients with metastatic pancreatic ductal adenocarcinoma.

Wainberg says that these head-to-head results are significant to community oncologists by answering the question of whether a 4-drug regimen is superior in efficacy to gemcitabine plus nab-paclitaxel in a patient with an ECOG performance status (PS) of 0 or 1 in this setting. He acknowledges that questions about using NALIRIFOX vs FOLFIRINOX (leucovorin calcium, fluorouracil (5FU), irinotecan, and oxaliplatin) will continue to be discussed as there is no head-to-head comparison between these regimens.

However, Wainberg says this study has answered a key question for oncologists and provided valuable data for NALIRIFOX as a reference regimen in this setting, enabling further optimizations to therapy for patients

TRANSCRIPTION:

0:08 | For the community oncology audience, which is the primary audience we hoped to help by doing this study, I think we can now safely answer the question that a 4-drug regimen, in this case NALIRIFOX, is superior to gemcitabine/nab-paclitaxel in an average ECOG [PS] 0/1 patient. That's my main conclusion. I think that there's obviously some nuance differences between FOLFIRINOX and NALIRIFOX that will be the subject of much discussion. But in terms of answering the question for the community, I think we can feel good that in an average ECOG [PS] 0/1 patient, we now have an answer to the question.