Journal article
Update on the role of nanoliposomal irinotecan in the treatment of metastatic pancreatic cancer
Therapeutic advances in gastroenterology, Vol.10(7), pp.563-572
07/2017
DOI: 10.1177/1756283X17705328
PMCID: PMC5484436
PMID: 28804517
Abstract
Median survival for patients with metastatic pancreatic cancer (MPC) treated with combination chemotherapeutic agents such as gemcitabine-based regimens and FOLFIRINOX is currently less than 12 months. This highlights the need for more efficacious first-line, as well as second-line therapies. Nanoliposomal irinotecan, in combination with 5-fluorouracil (5-FU)/folinic acid has recently been assessed as second-line therapy after initial gemcitabine-based therapy. It is the first, second-line treatment approved by the US Food and Drug Administration to treat patients with MPC based on results of the NAnoliPOsomaL Irinotecan (NAPOLI-1) study, which showed that this regimen significantly prolonged progression-free survival (3.1 months
versus
1.5 months) and overall survival (6.2 months
versus
4.1 months) compared with 5-FU/folinic acid alone. In addition, this study also represented an important step forward in improving the efficacy of previously used chemotherapeutic agents by using nanoformulation to extend pharmacokinetic advantages such as slow clearance, low steady-state volume of distribution, and longer half-life. However, certain adverse effects that are seen more frequently with nanoliposomal irinotecan and 5-FU/folinic acid, compared with 5-FU/folinic acid alone, include neutropenia, fatigue, diarrhea, and nausea/vomiting. This merits close monitoring of patients who are on this combination, since these adverse events may necessitate dose reductions and growth factor support. It is imperative to check
UGT1A1
gene status in all patients being considered for treatment with nanoliposomal irinotecan. Patients found to be homozygous for the
UGT1A1*28
gene need to be started on a lower initial dose. As we gain more data with clinical use, we anticipate further characterization of the aforementioned toxicities in patients with UGT1A1 gene polymorphisms and other genetic variants.
Details
- Title: Subtitle
- Update on the role of nanoliposomal irinotecan in the treatment of metastatic pancreatic cancer
- Creators
- FNU Asad ur Rahman - Internal Medicine Residency, Florida Hospital Orlando, Orlando, FL, USASaeed Ali - Internal Medicine Residency, Florida Hospital Orlando, Orlando, FL, USAMuhammad Wasif Saif - Professor of Medicine, Director of GI Oncology and Experimental Therapeutics, Tufts Cancer Center – Tufts Medical Center, 800 Washington Street, Box 245, Boston, MA 02111, USA
- Resource Type
- Journal article
- Publication Details
- Therapeutic advances in gastroenterology, Vol.10(7), pp.563-572
- Publisher
- SAGE Publications
- DOI
- 10.1177/1756283X17705328
- PMID
- 28804517
- PMCID
- PMC5484436
- ISSN
- 1756-283X
- eISSN
- 1756-2848
- Language
- English
- Date published
- 07/2017
- Academic Unit
- General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094349902771
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