Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr 4:16:17588359241234487.
doi: 10.1177/17588359241234487. eCollection 2024.

Integration of liposomal irinotecan in the first-line treatment of metastatic pancreatic cancer: try to do not think about the white bear

Davide Melisi  1   2 , Simona Casalino  3 , Silvia Pietrobono  3 , Alberto Quinzii  3 , Camilla Zecchetto  3 , Valeria Merz  3   4
Affiliations
Review

Integration of liposomal irinotecan in the first-line treatment of metastatic pancreatic cancer: try to do not think about the white bear

Davide Melisi et al. Ther Adv Med Oncol. .

Abstract

The approval of novel therapeutic agents remains widely reliant on evidence derived from large phase III randomized controlled trials. Liposomal irinotecan (ONIVYDE®) stands out as the only drug that has demonstrated improved survival both as a first-line therapy in combination with oxaliplatin and 5-fluorouracil/leucovorin (5FU/LV) (NALIRIFOX) compared to the standard gemcitabine plus nab-paclitaxel in the NAPOLI3 trial, and as a second-line treatment in combination with 5FU/LV compared to the standard 5FU/LV in the NAPOLI1 trial. However, just as the white bear of the Dostoevsky's paradox, the judgment of these results is invariably distracted by the intrusive thought of how different they might be if compared to similar regimens containing standard-free irinotecan as FOLFIRINOX or FOLFIRI, respectively. Here, we present and thoroughly discuss the evidence encompassing the pharmacologic, preclinical, and clinical development of liposomal irinotecan that can dispel any intrusive thoughts and foster a rational and well-considered judgment of this agent and its potential integration into the therapeutic strategies for pancreatic ductal adenocarcinoma.

Keywords: NALIRIFOX; liposomal irinotecan; pancreatic ductal adenocarcinoma.

PubMed Disclaimer

Conflict of interest statement

DM received honoraria as an advisory board member or consultant from Servier, Incyte, Tahio, iOnctura, Eli Lilly, Evotec, Shire, Baxter; received institutional support for research projects from Shire, Celgene, Incyte, iOnctura, Roche. All other authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
A possible novel paradigm for the development of experimental therapeutics for pancreatic ductal adenocarcinoma.
Figure 2.
Figure 2.
Optimal therapeutic sequences for metastatic pancreatic ductal adenocarcinoma upon approval of NALIRIFOX.
See this image and copyright information in PMC

References

    1. The Global Cancer Observatory. Pancreas, https://gco.iarc.fr/today/data/factsheets/cancers/13-Pancreas-fact-sheet... (2020, accessed 6 August 2023).
    1. Siegel RL, Miller KD, Wagle NS, et al.. Cancer statistics, 2023. CA Cancer J Clin 2023; 73: 17–48. - PubMed
    1. Rahib L, Wehner MR, Matrisian LM, et al.. Estimated projection of US Cancer incidence and death to 2040. JAMA Netw Open 2021; 4: e214708. - PMC - PubMed
    1. Tamburrino A, Piro G, Carbone C, et al.. Mechanisms of resistance to chemotherapeutic and anti-angiogenic drugs as novel targets for pancreatic cancer therapy. Front Pharmacol 2013; 4: 56. - PMC - PubMed
    1. Fountzilas E, Tsimberidou AM, Vo HH, et al.. Clinical trial design in the era of precision medicine. Genome Med 2022; 14: 101. - PMC - PubMed

LinkOut - more resources