Nanoliposomal irinotecan for treating pancreatic cancer

Introduction: Pancreatic cancer is a highly aggressive and lethal malignancy, with a particularly poor prognosis and limited treatment options, especially after development of gemcitabine-refractory disease. Nanoliposomal irinotecan (MM-398), is a novel formulation of irinotecan hydrochloride (CPT-11), exhibiting improved pharmacokinetic properties and bio-distribution to the tumor tissue in comparison to free-form irinotecan. MM-398, in combination with 5-fluorouracil (5-FU) and folinic acid (FA), is the first regimen approved by the Food and Drug Administration (FDA) as a second-line treatment in pancreatic cancer, following failure of gemcitabine-based induction chemotherapy. Areas covered: A critical overview of the pharmacology, clinical efficacy and toxicity of MM-398 in pancreatic cancer is herein presented and discussed within the context of currently available treatment strategies as well as in light of future perspectives in this field. Expert opinion: Incorporation of MM-398 as a second-line agent in routine clinical management of pancreatic cancer patients represents a breakthrough step forward in the treatment of this challenging disease. Future preclinical and clinical research should help delineate more clearly the full potential and limitations of this novel drug in pancreatic cancer therapeutics, disclose its potential synergies or interactions with other anticancer agents or regimens, and identify novel biomarkers for a more accurate prediction of its efficacy and toxicity.