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Gastrointestinal cancer

NALIRIFOX for metastatic pancreatic adenocarcinoma: hope or hype?

Nature Reviews Clinical Oncology (2024)Cite this article

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The FDA has approved nanoliposomal irinotecan, 5-fluorouracil, leucovorin and oxaliplatin (NALIRIFOX) for patients with metastatic pancreatic adenocarcinoma on the basis of results from the NAPOLI 3 trial, in which this four-drug regimen improved overall survival relative to a doublet regimen. Here we discuss how, in the context of prior results from the PRODIGE 4 trial testing 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (modified FOLFIRINOX), NALIRIFOX does not seem to raise the bar, but rather exposes patients and health-care systems to financial toxicities.

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Authors and Affiliations

  1. Division of Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Christopher Nevala-Plagemann & Ignacio Garrido-Laguna

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  1. Christopher Nevala-Plagemann
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  2. Ignacio Garrido-Laguna
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Correspondence to Ignacio Garrido-Laguna.

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Competing interests

C.N.-P. receives institutional research funding from Theriva and has had an advisory role at Seagen. I.G.-L. receives institutional research funding from Revolution Medicine, Quanta Therapeutics, 280 Bio, Bayer, BridgeBio Pharma, Bristol–Myers Squibb, GlaxoSmithKline, Incyte, Jacobio, Lilly, MedImmune, Novartis, Pfizer, Repare Therapeutics, Sumitomo Dainippon Pharma Oncology and Tolero Pharmaceuticals; and has had consulting or advisory roles at Jazz, Kanaph, OncXer, Revolution Medicine and SOTIO.

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Nevala-Plagemann, C., Garrido-Laguna, I. NALIRIFOX for metastatic pancreatic adenocarcinoma: hope or hype?. Nat Rev Clin Oncol (2024). https://doi.org/10.1038/s41571-024-00896-w

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