Response to Letter to the Editor: ‘NALIRIFOX versus nab-paclitaxel and gemcitabine in older patients with treatment-naive metastatic pancreatic cancer: a subgroup analysis of the pivotal NAPOLI 3 trial’

Teresa Macarulla; R.Pazo Cid; M.S. Womack; A. Cubillo Gracian; A. Zervoudakis; H. Hatoum; V. Chung; A. Patel; A.S. Paulson; S. Pant; Eileen M. O’Reilly; R. Hubner; E. Van Cutsem; Tanios Bekaii‐Saab; L. Zhang; J Li; H. Chen; F. Maxwell; Z.A. Wainberg; D. Melisi

doi:10.1016/j.esmoop.2026.108307

Key Points

To address the efficacy of NALIRIFOX in improving survival among older patients with treatment-naive metastatic pancreatic ductal adenocarcinoma.
Reviewed commentary from Kahl et al. regarding previous analysis.
Affirmed findings based on subgroup of patients with performance status of 0-1 from the NAPOLI 3 trial.
Evidence supports that NALIRIFOX improves survival compared to gemcitabine plus nab-paclitaxel.
Conclusions hold true irrespective of patient age.

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Implication

Letter response confirms NALIRIFOX improves survival in older patients with metastatic pancreatic cancer, suggesting significant treatment implications.

Abstract

We read with interest the Letter to the Editor in the current issue from Kahl et al., regarding the article ‘NALIRIFOX versus nab-paclitaxel and gemcitabine in older patients with treatment-naive metastatic pancreatic cancer: a subgroup analysis of the pivotal NAPOLI 3 trial’.1 We thank Kahl et al. for their careful commentary on our analysis. While we agree with several of their points, we continue to believe that, for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) with an Eastern Cooperative Oncology Group performance status score of 0-1 enrolled in the trial, our evidence supports the conclusion that NALIRIFOX improved survival versus gemcitabine plus nab-paclitaxel (Gem + NabP) irrespective of age.

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Cite This Study

Macarulla et al. (2026) studied this question.

synapsesocial.com/papers/6a532e624f7abc118adecc55 https://doi.org/10.1016/j.esmoop.2026.108307

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Response to Letter to the Editor: ‘NALIRIFOX versus nab-paclitaxel and gemcitabine in older patients with treatment-naive metastatic pancreatic cancer: a subgroup analysis of the pivotal NAPOLI 3 trial’

Key Points

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Discussion

Cite This Study

Response to Letter to the Editor: ‘NALIRIFOX versus nab-paclitaxel and gemcitabine in older patients with treatment-naive metastatic pancreatic cancer: a subgroup analysis of the pivotal NAPOLI 3 trial’

Key Points

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Implication

Abstract

Discussion

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