title: Nanoliposomal irinotecan plus fluorouracil and folinic acid: a new treatment option in metastatic pancreatic cancer.
abstract: Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with half of patients diagnosed in the metastatic setting. Until recently, patients after progression on front-line gemcitabine-based regimen had no standard second-line option, although flouropyrimidine-based regimens were frequently used in this setting. Encapsulation of chemotherapeutics in liposomal formulation is an effective way of prolonging drug deposition thereby enhancing cytotoxic efficacy. In a large phase III randomized trial on metastatic PDAC patients who progressed after gemcitabine-based chemotherapy, a novel nanoliposome-encapsulated irinotecan (PEP02, MM-398, nal-IRI, Onivyde, Merrimack, Boston, US) plus fluorouracil and folinic acid demonstrated a significant survival advantage compared to fluorouracil and folinic acid alone. This pivotal study led to the recent FDA approval of nanoliposomal irinotecan in patients with metastatic PDAC. In this article, we will review the literature regarding existing treatment options for metastatic PDAC, focusing specifically on nanoliposomal irinotecan in the clinical setting and its future implication.
authors.affiliation: a Division of Oncology, Department of Medicine , Washington University in St. Louis , St. Louis , MO , USA.
authors.forename: Sana Saif
authors.initials: SS
authors.lastname: Ur Rehman
authors.affiliation: a Division of Oncology, Department of Medicine , Washington University in St. Louis , St. Louis , MO , USA.|b Siteman Cancer Center , Washington University School of Medicine , St. Louis , MO , USA.
authors.forename: Kian
authors.initials: K
authors.lastname: Lim
authors.affiliation: a Division of Oncology, Department of Medicine , Washington University in St. Louis , St. Louis , MO , USA.|b Siteman Cancer Center , Washington University School of Medicine , St. Louis , MO , USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wang-Gillam
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000473:pathology; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008081:Liposomes; D053758:Nanoparticles; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic
chemical_list: D008081:Liposomes; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Nanoliposomal irinotecan; clinical trials; gemcitabine-refractory; metastatic pancreatic cancer; second-line chemotherapy