Eileen M. O'Reilly, MD: Role of Liposomal in Nanoliposomal Irinotecan

What role in the mechanism of action might the liposomal component play for nanoliposomal irinotecan?

While I think this is interesting, I think we don’t know for sure, but it is an attractive delivery system. There might be more active drug at the tumor site, contributing to greater efficacy and there might be less metabolized and free drug in the circulation not being well utilized. A slower delivery mechanism over a longer period of time may also contribute to improved outcomes.

There is this question of whether toxicity may benefit from liposomal formulation. I don’t think we know that from the NAPOLI-1 trial data, and ultimately comparative assessments with irinotecan itself may help us understand whether that is so. But the formulation is attractive, from the delivery perspective, and may contribute to some of the improvement in outcome that’s been identified.

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.