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

Author:

Melisi Davide12ORCID,Casalino Simona3,Pietrobono Silvia3,Quinzii Alberto3,Zecchetto Camilla3,Merz Valeria34ORCID

Affiliation:

1. Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

2. Digestive Molecular Clinical Oncology Research Unit, University of Verona, Piazzale L.A. Scuro, 10, Verona 37134, Italy

3. Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy

4. Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy

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.

Funder

Associazione Italiana per la Ricerca sul Cancro

Ministero dell'Istruzione e del Merito

Ministero della Salute

Publisher

SAGE Publications

Reference67 articles.

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