<![CDATA[Dr Cohen on Frontline Chemotherapy Selection in Metastatic Pancreatic Cancer ]]>

Commentary|Videos|May 5, 2026 Supplements and Featured Publications Personalizing Frontline Chemotherapy Selection in Metastatic Pancreatic Cancer Volume 1 Issue 1 Dr Cohen on Frontline Chemotherapy Selection in Metastatic Pancreatic Cancer Author(s)Deirdre J. Cohen, MD Fact checked by: Courtney Flaherty, Caroline Seymour Deirdre J. Cohen, MD, MS, discusses clinical decision-making and the comparative efficacy of FOLFIRINOX and NALIRIFOX in metastatic pancreatic cancer. “In 2026, we still do not have the perfect answer or biomarker for selecting a frontline [treatment] regimen, outside of homologous recombination deficiency or DNA damage response alterations... where we know that patients derive more benefit from a platinum-containing regimen.”Deirdre J. Cohen, MD, MS, the director of the Gastrointestinal Oncology Program for the Mount Sinai Health System, an associate professor of medicine (Hematology and Medical Oncology), and the medical director of the Cancer Clinical Trials Office at The Tisch Cancer Institute, discussed factors informing therapeutic selection for patients with metastatic pancreatic cancer in the front line.Until early 2024, the frontline standard of care was primarily limited to modified FOLFIRINOX (leucovorin, fluorouracil [5-FU], irinotecan, and oxaliplatin) and the doublet of gemcitabine plus nab-paclitaxel (Abraxane). This paradigm shifted in February 2024 with the FDA approval of NALIRIFOX (irinotecan liposome [Onivyde], oxaliplatin, 5-FU, and leucovorin) based on data from the phase 3 NAPOLI 3 trial (NCT04083235).Established level 1 evidence shows NALIRIFOX has superior efficacy compared with gemcitabine plus nab-paclitaxel; however, because there is no level 1 evidence comparing NALIRIFOX with FOLFIRINOX, it remains unclear if one regimen is inherently superior to the other, Cohen noted.In the absence of a “perfect answer” or universal biomarker, Cohen explained that treatment selection often relies on specific genetic alterations. Patients with homologous recombination deficiency or DNA damage response alterations—such as mutations in BRCA or PALB2—typically derive greater benefit from platinum-containing regimens. Beyond these markers, the clinical data must be weighed alongside patient preferences regarding logistics, delivery schedules, and potential toxicities, she stated.Comorbidities and performance status are also critical factors in this decision-making process, Cohen added. For patients with a good performance status, Cohen generally leans toward prescribing FOLFIRINOX. Conversely, NALIRIFOX may be the preferred choice for patients where there is a significant concern regarding pre-existing peripheral neuropathy, she asserted. Ultimately, the choice between these intensive regimens requires a nuanced discussion between the oncologist and the patient to align the therapy with the individual's clinical needs, Cohen concluded. Articles in this issue21 days agoArticlePatient-Centered Approaches Are Vital for Navigating Treatment Decisions in Pancreatic Cancer24 days agoVideoGallagher on How Nurses Support Patient Goals After Initial Diagnosis of Pancreatic Cancerabout 2 months agoArticleIncreasing Representation of Women in GI Oncology Research Is Shaping the Future of Pancreatic Cancer Managementabout 2 months agoVideoDr Shroff on Empowering Women in GI Oncology Research2 months agoPodcastTreatment Evolutions Affect First-Line Chemotherapy Selection in Metastatic Pancreatic Cancer: With Rachna T. Shroff, MD, MS, FASCO; and Kristen Spencer, DO3 months agoArticlePatient Preferences, Expected Toxicity Serve As Guiding Factors for Frontline Chemo Selection in Pancreatic Cancer3 months agoVideoDr Spencer on First-Line Chemo Selection in Metastatic Pancreatic Adenocarcinoma3 months agoArticleAligning Patient Goals and Toxicity Burden Are Key in First-Line Chemo Selection in Pancreatic Cancer NewsletterStay up to date on the most recent and practice-changing oncology dataSubscribe Now! Related ContentDr Gruenbaum on Where Alternative Options to BTK Inhibitors Stand in MCLByLore Gruenbaum, PhDMay 8th 2026Dr Sznol on Optimal Treatment Sequencing in MelanomaByMario Sznol, MDMay 7th 2026Mentorship Is Key to Advance the Next Generation of Oncology ResearchersByKyle Doherty May 7th 2026Dr Mauro on the Significance of Alternative TKI Formulations in CMLByMichael J. Mauro, MDMay 7th 2026Dr Olawaiye on the FDA Approval of Relacorilant Plus Nab-Paclitaxel in PROCByAlexander B. 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