Dr Chung talks to ecancer at ASCO 2025 about the NAPOLI 3 phase 3 trial which evaluated the effectiveness of the NALIRIFOX regimen (liposomal irinotecan plus 5-fluorouracil/leucovorin and oxaliplatin) in treating patients with metastatic pancreatic ductal adenocarcinoma (mPDAC), a cancer known for its poor prognosis.

In this post hoc analysis of North American participants (n=120), 15 long-term survivors—defined as those living ≥18 months—were studied to identify clinical and treatment factors associated with extended survival.

These patients had a median overall survival of 19.5 months and were characterized by a younger median age (61 years), relatively good performance status (ECOG PS 0 in over half), and lower CA 19-9 levels at baseline.

Notably, a high proportion of these long-term survivors had tumours in the body of the pancreas, and many had advanced disease, including liver metastases and ≥3 metastatic sites. Despite this, most underwent dose reductions and delays for both irinotecan and oxaliplatin but still received high cumulative drug doses over an extended period, suggesting that treatment intensity and duration, even with modifications, contributed to improved outcomes.

These findings indicate that selected patients with favourable clinical profiles may achieve long-term survival with NALIRIFOX, although the small sample size limits broader conclusions.