Excellent Survival Outcome in a Patient Receiving NALIRIFOX for Metastatic Pancreatic Adenocarcinoma: A Case Report

Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is frequently diagnosed at an advanced stage and remains associated with poor survival outcomes. Durable responses to systemic therapy in metastatic disease are uncommon. We report a case of metastatic PDAC with prolonged survival and sustained response following first-line treatment with NALIRIFOX. This report describes a patient with metastatic PDAC who achieved prolonged disease control and sustained response following first-line treatment with NALIRIFOX. Case Presentation: A 64-year-old woman presented with abdominal pain, early satiety, weight loss, and markedly elevated CA 19-9 levels. Imaging demonstrated a pancreatic head mass with multiple hepatic metastases, and biopsy confirmed metastatic poorly differentiated PDAC. The patient initiated first-line therapy with NALIRIFOX as part of the NAPOLI-3 protocol and completed 20 cycles over approximately 25 months. Following an early treatment delay secondary to grade 2 neutropenia, she achieved substantial biochemical and radiographic improvement. After eight cycles, imaging demonstrated marked radiographic response with disappearance of the pancreatic lesion and marked regression of hepatic metastases. Disease stability was maintained for more than two years before progression was identified in a dominant hepatic lesion after cycle 20. Conclusion: This case highlights the potential for prolonged disease control and extended survival with NALIRIFOX in metastatic PDAC, emphasizing the meaningful clinical benefit that may be achieved in selected patients despite historically poor outcomes.