{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:40:46Z","timestamp":1777876846083,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Med Oncol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pancreatic adenocarcinoma has a high mortality rate. Nanoliposomal irinotecan plus 5-fluorouracil and leucovorin (nal-IRI\/FL) is the standard second-line chemotherapy after gemcitabine-based therapy. Although nanoliposomal irinotecan plus oxaliplatin, fluorouracil, and leucovorin (NALIRIFOX) has shown superior efficacy as first-line therapy over gemcitabine and nab-paclitaxel, its roles as second-line therapy remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We aimed to compare the clinical outcomes and safety profiles of NALIRIFOX and nal-IRI\/FL when used as a second-line treatment for patients with pancreatic adenocarcinoma who have progressed on a gemcitabine-based therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Designs:<\/jats:title>\n                    <jats:p>This was a single-center retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included patients with locally advanced or metastatic pancreatic adenocarcinoma who received NALIRIFOX or nal-IRI\/FL following progression on first-line gemcitabine-based therapy from September 2020 to October 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 62 patients in the NALIRIFOX group and 131 in the nal-IRI\/FL group were analyzed. Cumulative dose intensity \u2a7e80% over four cycles was achieved in 81.4% of the NALIRIFOX group and 73.1% of the nal-IRI\/FL group (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.32). The median progression-free survival (PFS) was 4.0\u2009months (95% confidence interval (CI): 3.6\u20134.5) in the NALIRIFOX group versus 2.5\u2009months (95% CI: 2.1\u20133.0) in the nal-IRI\/FL group (hazard ratio (HR): 0.686; 95% CI: 0.497\u20130.947;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.021), and the median overall survival was 7.0\u2009months (95% CI: 5.0\u20139.1) versus 6.3\u2009months (95% CI: 4.4\u20138.1), respectively (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.827). Of the patients with disease progression after nal-IRI\/FL, 69.1% received oxaliplatin-containing chemotherapy. Grade 3\u20134 adverse events were more frequent with NALIRIFOX, including febrile neutropenia, neutropenia, thrombocytopenia, and peripheral neuropathy; however, most were transient and manageable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>NALIRIFOX provides superior PFS compared to nal-IRI\/FL as second-line therapy for advanced or metastatic pancreatic cancer after gemcitabine failure. Although NALIRIFOX was associated with higher rates of hematologic and neurologic toxicities, they were manageable with careful monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17588359261431386","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:57:25Z","timestamp":1773914245000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["NALIRIFOX versus liposomal irinotecan plus fluorouracil\/leucovorin as the second-line chemotherapy in gemcitabine refractory pancreatic adenocarcinoma: a real-world study"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4446-0576","authenticated-orcid":false,"given":"Wei-Ze","family":"Wong","sequence":"first","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nai-Jung","family":"Chiang","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuei-Chuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung-Yuan","family":"Yu","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Jui","family":"Tsai","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4884-634X","authenticated-orcid":false,"given":"Shao-Jung","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan"},{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei-Chang","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan"},{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Huang","family":"Chen","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Chun","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Endoscopy Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2123-8264","authenticated-orcid":false,"given":"Chung-Pin","family":"Li","sequence":"additional","affiliation":[{"name":"Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, 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