New Treatment Option for Metastatic Pancreatic Cancer – Pegylated Liposomal Irinotecan
The 2019 review article is dedicated to the use of nanoliposomal irinotecan, its toxicity, and its potential use in the treatment sequence of metastatic pancreatic ductal adenocarcinoma.
Treatment Options for Metastatic Pancreatic Cancer
Pancreatic cancer is a disease with high mortality and increasing incidence. The most common histological type is pancreatic ductal adenocarcinoma (PDAC), which metastasizes early. The basis of treatment for metastatic pancreatic cancer has long been gemcitabine. Since 2010, the FOLFIRINOX regimen (leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin) or combinations such as nab-paclitaxel and gemcitabine have been used in the first line of treatment.
Benefits of Nanoliposomal Irinotecan in Patients Previously Treated with Gemcitabine
Nanoliposomal irinotecan (nal-IRI) was developed as a new form of irinotecan that improves drug availability and efficacy with lower systemic toxicity. In the large phase III randomized study NAPOLI-1, the addition of nal-IRI to fluorouracil modulated by leucovorin (5-FU/LV) significantly prolonged overall survival (OS) in patients who had progressed on previous gemcitabine therapy. The combination of nal-IRI with 5-FU/LV also improved progression-free survival (PFS), increased the objective response rate to treatment, prolonged the time to treatment failure, and improved response of the tumor marker CA 19-9, demonstrating its antitumor efficacy.
Nal-IRI has demonstrated its benefit in prolonging overall survival even in subsequent studies conducted in real clinical practice. The combination of nal-IRI + 5-FU/LV has become a generally accepted choice in the second line of treatment for PDAC after a gemcitabine regimen.
Toxicity of Therapy
Nal-IRI is also associated with a number of adverse events, particularly diarrhea, nausea, vomiting, and myelosuppression (primarily neutropenia), which are well manageable in clinical practice. Dose reductions were necessary in about one-third of patients in the studies.
Conclusion
Recent data suggest that administering nal-IRI earlier in the therapeutic sequence can significantly prolong OS and PFS. A number of studies with nal-IRI are now ongoing in both early and late stages of pancreatic cancer.
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Sources:
1. Woo W., Carey E. T., Choi M. Spotlight on liposomal irinotecan for metastatic pancreatic cancer: patient selection and perspectives. Onco Targets Ther 2019; 12: 1455−1463, doi: 10.2147/OTT.S167590.
2. SPC Onivyde. Available at: www.servier.cz/documents/SPC/Onivyde_SPC.pdf
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