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ESMO 2025 | FOOTPATH: NAPOLI and mFOLFOX6 in first-line metastatic pancreatic cancer
Benedikt Westphalen, MD, Ludwig Maximilian University (LMU) Hospital Munich, Munich, Germany, discusses the Phase II FOOTPATH study (NCT03487016) of first-line treatment strategies in metastatic pancreatic cancer. The study compared gemcitabine/nab-paclitaxel, NAPOLI (liposomal irinotecan and 5-FU/folinic acid), and sequential NAPOLI followed by mFOLFOX6. Sequential NAPOLI/mFOLFOX6 improved progression-free survival and showed a trend toward longer overall survival compared with gemcitabine/nab-paclitaxel, while NAPOLI monotherapy did not. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
What we found in FOOTPATH was that if you sequence FOLFOX and FOLFIRI, you retain a good efficacy in terms of progression-free survival, but you also have lower toxicities. So your patients, upon being progressive on the first line regimen, still have reserves in terms of bone marrow reserve or polyneuropathy to go on to other treatment regimens. And also looking into the future, we’re now talking about combining RAS inhibitors and novel agents with frontline chemotherapy...
What we found in FOOTPATH was that if you sequence FOLFOX and FOLFIRI, you retain a good efficacy in terms of progression-free survival, but you also have lower toxicities. So your patients, upon being progressive on the first line regimen, still have reserves in terms of bone marrow reserve or polyneuropathy to go on to other treatment regimens. And also looking into the future, we’re now talking about combining RAS inhibitors and novel agents with frontline chemotherapy. If you’re stacking up multiple agents, chemo plus targeted agents, it might really get a little bit toxic. If you know that you can split at least a chemotherapeutic backbone and top that up with a targeted agent, that could be informative for the future.
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