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[Comment] Gemcitabine-resistant pancreatic cancer: a second-line option

In The Lancet, Andrea Wang-Gillam and colleagues1 report on a randomised phase 3 trial (NAPOLI-1) in 417 patients with metastatic gemcitabine-resistant pancreatic cancer. The primary endpoint of overall survival was improved significantly with the combination of nanoliposomal irinotecan plus fluorouracil and folinic acid when compared with a control of fluorouracil and folinic acid (6·1 months [95% CI 4·8–8·9] vs 4·2 months [3·3–5·3]; hazard ratio [HR] 0·67, 95% CI 0·49–0·92). Subgroup analyses consistently favoured the combination treatment, further supporting a robust treatment effect on overall survival.