Eileen M. O'Reilly, MD: Expected Response with Liposomal Irinotecan

What level of response would you anticipate with the liposomal irinotecan regimen for this patient, based on data published in The Lancet earlier this year?

There is a RECIST response rate that’s seen and that’s in the 10% plus range, which I think is meaningful. We see more patients with stable disease, but we do see overt responses in the second-line setting and that always catches our eye in this disease to see actual tumor regression beyond a frontline setting. With regard to 5-FU and leucovorin, the control arm had a very low single-digit response rate, so there was a significant response difference in outcome. The other parameters that would support that were the progression-free survival advantage that was identified and CA19-9 improvements. The data were consistent in terms of indicating that there was a value over 5-FU and leucovorin for the triplet combination.

Metastatic Pancreatic Cancer: Case 2

Henry R was diagnosed with adenocarcinoma in the body of the pancreas when he was 64 years old, following rapid weight loss, abdominal pains, and the development of venous thrombosis.

• At diagnosis, measurable distant lymph node, liver, and lung metastases were observed
• His CA19-9 level was 2760 U/ml and his concentration of albumin was 28 g/L. His ECOG performance status was 1.

Upfront treatment was administered with nab-paclitaxel and gemcitabine, which lasted for 4months:

• At the time of progression, pain levels had increased interfering with daily activity and raising the ECOG performance status to a 2.
• At this point, second-line therapy was initiated with liposomal irinotecan, fluorouracil, and folinic acid.