Metastatic pancreatic adenocarcinoma: second-line naI-IRI plus 5-FU/LV

Presented by

Prof. Kyunghye Bang, Asan Medical Center, Korea

Conference

ASCO GI 2021

Patients with metastatic pancreatic adenocarcinoma who progressed after conventional irinotecan-based therapies were treated with liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (5-FU/LV), with manageable toxicities. Furthermore, the cumulative dose of prior conventional irinotecan-based therapy may be inversely correlated with response to nal-IRI plus 5-FU/LV.

Prof. Kyunghye Bang (Asan Medical Center, Korea) presented this multicentre retrospective analysis [1]. The rationale was that although nal-IRI plus 5-FU/LV has demonstrated clinical benefit in patients with metastatic pancreatic adenocarcinoma who progressed after gemcitabine-based chemotherapy, this therapy on patients previously treated with conventional irinotecan has not been investigated.

All patients (n=35; median age 58 years) received prior irinotecan as the component of FOLFIRINOX. The median duration of prior irinotecan was 4.6 months and median cumulative dose of prior irinotecan was 1,230 mg (range 150-4,650 mg). The objective response rate to nal-IRI plus 5-FU/LV was 2.9% and stable disease was achieved in 31.4%. With median follow-up duration of 9.2 months, the median PFS and OS were 2.0 months and 4.4 months, respectively; 6-month PFS rate was 16.3% and OS rate was 37.5% (see Table).

Table: Outcomes of nal-IRI plus 5-FU/LV [1]

The investigators measured the ratio of time-to-progression with nal-IRI plus 5-FU/LV versus time-to-progression with conventional irinotecan (0.41; range 0.07-2.07), and observed a negative correlation with the cumulative dose of prior irinotecan (R=-0.37; P=0.041). Similarly, the duration of prior irinotecan exposure was also negatively correlated to the time-to-progression with nal-IRI plus 5-FU/LV, although this did not reach statistical significance (R=-0.35; P=0.062).

Bang K, et al. Efficacy and safety of liposomal irinotecan plus fluorouracil/leucovorin after progression on conventional irinotecan-containing chemotherapy for metastatic pancreatic adenocarcinoma. ASCO Gastrointestinal Cancers Symposium 2021, 15-17 January. Abstract 382.

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