Farshid Dayyani, MD

Panelist discusses how NALIRIFOX (liposomal irinotecan, 5-fluorouracil, leucovorin, oxaliplatin) represents a reasonable treatment option for patients with excellent performance status and locally advanced pancreatic adenocarcinoma, requiring close monitoring and proactive toxicity management to maximize outcomes.

Panelist discusses how post hoc analyses of the NAPOLI-3 trial revealed that dose reductions for toxicity management do not adversely affect overall survival and that UGT1A1 mutations do not significantly impact treatment tolerability with nanoliposomal irinotecan.

Panelist discusses how NALIRIFOX (liposomal irinotecan, 5-fluorouracil [5-FU], leucovorin, oxaliplatin) management requires careful attention to cytopenia prevention through growth factor use and aggressive diarrhea management with patient education and antidiarrheal medications.

Panelist discusses how the development of nanoliposomal irinotecan led to the NAPOLI-1 trial showing a survival benefit in second-line treatment and subsequently the NAPOLI-3 trial demonstrating the superiority of NALIRIFOX (liposomal irinotecan, 5-fluorouracil [5-FU], leucovorin, oxaliplatin) over gemcitabine/nab-paclitaxel in first-line metastatic disease.

Panelist discusses how the landmark ACCORD 11 trial established FOLFIRINOX (leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin) as superior to gemcitabine for fit, young patients, whereas the MPACT trial demonstrated that gemcitabine plus nab-paclitaxel provided a more tolerable option for older patients with less preserved performance status.

Panelist discusses how CA 19-9 serves as a useful tumor marker for disease monitoring and recurrence detection in patients with pancreatic cancer, though it requires normalization of bilirubin levels for accurate baseline assessment.

Panelist discusses how genetic testing is recommended for all patients with pancreatic adenocarcinoma at diagnosis, including both germline testing for hereditary cancer syndromes and tumor profiling using next-generation sequencing (NGS) assays to identify actionable mutations.

Panelist discusses how pancreatic adenocarcinoma remains one of the deadliest cancers with poor survival rates, presenting a case of a 58-year-old patient with locally advanced disease and reviewing National Comprehensive Cancer Network treatment guidelines that mirror metastatic disease approaches.