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Comparison of conventional versus liposomal irinotecan in combination with fluorouracil for advanced pancreatic cancer: a single-institution experience

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Abstract

The majority of pancreatic cancers are diagnosed at an advanced stage, when surgical options are limited and treatment relies on systemic chemotherapy. In the NAPOLI-1 trial, liposomal irinotecan in combination with fluorouracil (nal-iri/5FU) was shown to improve overall survival when compared to fluorouracil alone for metastatic pancreatic cancer. Other retrospective studies have shown the combination of fluorouracil and conventional irinotecan (FOLFIRI) to be a viable option, though no randomized trials have compared nal-iri/5FU to FOLFIRI. The purpose of this single-center, retrospective, cohort study was to determine if nal-iri/5FU and FOLFIRI are similarly effective for the treatment of advanced pancreatic cancer. Due to the potential for treatment bias, inverse probability of treatment weighting was utilized to correct for baseline differences between the groups. The primary outcome of progression-free survival was similar at 4.1 months for nal-iri/5FU and 3.1 months for FOLFIRI. Overall survival and adverse effect frequency were also similar. Pegfilgrastim was used in 16% and 15% of patients, respectively, and nal-iri/5FU patients required significantly less atropine during treatment (36 vs. 70%). A cost analysis was conducted and concluded that the treatment with nal-iri/5FU was nearly 30 times more expensive than FOLFIRI treatment. Together, these data suggest a potential role for FOLFIRI for the treatment of advanced pancreatic cancer in the absence of clear benefits in effectiveness, toxicity, or cost for nal-iri/5FU.

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Authors and Affiliations

  1. Department of Pharmacy, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, 460 West 10th Avenue, Columbus, OH, 43210, USA

    Justin C. Tossey, Joshua Reardon & Matthew J. Arango

  2. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, 460 West 10th Avenue, Columbus, OH, USA

    Jeffrey B. VanDeusen & Anne M. Noonan

  3. Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, 1800 Cannon Drive, Columbus, OH, USA

    Kyle Porter

Authors
  1. Justin C. Tossey
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  2. Joshua Reardon
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  3. Jeffrey B. VanDeusen
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  4. Anne M. Noonan
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  5. Kyle Porter
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  6. Matthew J. Arango
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Correspondence to Matthew J. Arango.

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Conflict of interest

Anne Noonan served as a paid member of the Data Safety Monitoring Board for Helsinn in 2015–2016 and a paid advisory board member for QED Therapeutics and Exelixis in 2019. No other authors have any potential conflicts to declare.

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Tossey, J.C., Reardon, J., VanDeusen, J.B. et al. Comparison of conventional versus liposomal irinotecan in combination with fluorouracil for advanced pancreatic cancer: a single-institution experience. Med Oncol 36, 87 (2019). https://doi.org/10.1007/s12032-019-1309-6

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  • DOI: https://doi.org/10.1007/s12032-019-1309-6

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