Patients with unresectable pancreatic cancer who receive second-line treatment with nanoliposomal irinotecan in combination with fluorouracil and folinic acid may remain eligible for subsequent third-line chemotherapy. New research had assessed treatment efficacy and prognostic indicators.
Investigators conducted a retrospective analysis of individuals with advanced pancreatic cancer who had progressed after first-line gemcitabine plus nab-paclitaxel. Participants were treated with nanoliposomal irinotecan, fluorouracil, and folinic acid as a second-line regimen. The study focused on outcomes of patients who advanced to third-line therapy, with the primary endpoints including progression-free survival, overall survival, and identification of factors linked to treatment benefit.
Results demonstrated that a subset of patients tolerated third-line chemotherapy following the folinic acid–based combination, with clinical benefit observed in terms of survival extension and disease control. Prognostic indicators were identified that may help guide treatment selection, including performance status and biochemical markers measured at baseline. The findings suggest that a carefully chosen third-line regimen can provide meaningful disease management opportunities for select patients who have already received two prior systemic therapies.
The authors noted that while pancreatic cancer remains one of the most aggressive and treatment-resistant malignancies, sequencing therapies beyond the second line is becoming increasingly relevant as supportive care improves and novel regimens become more tolerable. The study highlights the importance of optimizing treatment pathways for patients with unresectable disease, as well as refining prognostic tools that can aid clinicians in decision-making when considering third-line chemotherapy.
These findings underline the potential of nanoliposomal irinotecan combined with fluorouracil and folinic acid as an important bridge regimen, enabling patients to access additional lines of therapy. The authors concluded that identifying prognostic factors and establishing practical criteria for patient selection are essential steps toward improving outcomes in advanced pancreatic cancer.
Reference: Miwa K et al. Efficacy of third-line chemotherapy following nanoliposomal irinotecan combined with fluorouracil and folinic acid as second-line treatment for unresectable pancreatic cancer. Front Oncol. 2025;15:1626689.
