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Spotlight on liposomal irinotecan for metastatic pancreatic cancer: patient selection and perspectives

Authors Woo W, Carey ET, Choi M

Received 6 November 2018

Accepted for publication 15 January 2019

Published 21 February 2019 Volume 2019:12 Pages 1455—1463


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Carlos E Vigil

Wonhee Woo, Edward T Carey, Minsig Choi

Division of Hematology/Oncology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA

Abstract: Pancreatic cancer is a highly lethal disease, where the mortality closely matches increasing incidence. Pancreatic ductal adenocarcinoma (PDAC) is the most common histologic type that tends to metastasize early in tumor progression. For metastatic PDAC, gemcitabine had been the mainstay treatment for the past three decades. The treatment landscape has changed since 2010, and current first-line chemotherapy includes triplet drugs like FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin), and doublet agents like nab-paclitaxel and gemcitabine. Nanoliposomal encapsulated irinotecan (nal-IRI) was developed as a novel formulation to improve drug delivery, effectiveness, and limit toxicities. Nal-IRI, in combination with leucovorin-modulated fluorouracil (5-FU/LV), was found in a large randomized phase III clinical trial (NAPOLI-1) to significantly improve overall survival in patients who progressed on gemcitabine-based therapy. This review will focus on the value of using nal-IRI, toxicities, recent clinical experiences, and tools to improve patient outcomes in this setting.

Keywords: liposomal irinotecan, nal-IRI, pancreatic cancer, pancreatic ductal adenocarcinoma, refractory cancer

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