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In this Korean retrospective review of >6MM patients, heavy ethanol consumption in patients between 20-39 years of age was associated with associated with about a 20% increased risk of pancreatic cancer. This should be taken with a grain of salt (not on your margarita) but does suggest a dose dependent effect of ethanol use and pancreatic cancer risk.

PAXG (capecitabine 1250 mg/m² total daily dose administered as 625 mg/m² twice daily, plus intravenous cisplatin 30 mg/m², nab-paclitaxel 150 mg/m², and gemcitabine 800 mg/m² every 14 days) significantly improved event-free survival (EFS) compared with modified FOLFIRINOX (mFOLFIRINOX) in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) (16.0 months vs 10.2 months).

The GENERATE/JCOG1611 trial in Japanese patients with metastatic or recurrent PDAC found that neither mFOLFIRINOX nor S-IROX improved overall survival (OS) versus nab-paclitaxel/gemcitabine (median OS 14.0 vs 13.6 vs 17.0 months; hazard ratio (HR) ≈1.29), and the study was stopped early for futility. Progression-free survival (PFS) was similar across arms (≈5.8–6.7 months) but nab-paclitaxel/gemcitabine had fewer grade 3–4 GI toxicities and less febrile neutropenia, supporting its continued use in this population. The OS difference likely reflects more effective second-line sequencing after nab-paclitaxel/gemcitabine, including liposomal irinotecan, rather than intrinsic superiority. In Western studies, NALIRIFOX outperformed Nab-P/Gem, but in the Japanese trial, Nab-P/Gem remained at least as effective as triplet regimens, likely due to differences in patient population, sequencing, and access to second-line therapies.

Japanese studies, which included S-1 with oxaliplatin and irinotecan—both 5-FU–based regimens—showed no superiority to gemcitabine/nab-paclitaxel in first- or second-line therapy. The trial was terminated for futility. So, what is your regimen du jour?

I recall this trial well, in node-negative pancreatic cancer GemCap is a better option than gemcitabine alone in patients who can’t be treated with mFOLFIRINOX with improved five-year overall survival (OS) 59 vs 53%, hazard ratio (HR) 0.63.

Interesting study using local therapy in metastatic pancreatic ductal adenocarcinoma (MPDAC) patients with <=5 metastatic sites. I would really like to see overall survival data here as I think progression-free survival (PFS) is a tricky endpoint to use in a trial like this. Most likely the study arm will take a lot longer to demonstrate progression if all lesions are ablated, but most important to me is the quality of life, survival and overall exposure to cytotoxic therapy; the last of which is likely much better with local therapy being utilized.

CAR-T agent for refractory met-pancreas showing a median duration of response of 9.5 months. These treatments are far from widely available, but the proof of principle is nice to see in a disease that otherwise has not had responses to immunotherapy. Hopefully more agents to come.

Asian study of nimotuzumab (humanized EGFR-inhibitor) + gemcitabine (gem) vs. gem alone. The overall survival (OS) was 10.9 vs. 8.5 months in favor of the combination arm. While the OS difference is small, recall that the OS in the NALIRIFOX and FOLFIRINOX studies are similar. The safety profile of nimotuzumab + gemcitabine is superior to a triplet or double cytotoxic chemotherapy combination regimen. This drug is currently not available in the USA but is approved for nasopharyngeal carcinoma in China.

You may have enrolled a patient in this trial, but it seems we may have a new first line regimen. Surprisingly toxicity simar in both arms, but there was improvement in PFS and OS (17% reduction in death) although it wasn’t statistically significant in OS.
More diarrhea with nalirifox, but more neutropenia with gem abraxane.