Liposomal irinotecan in metastatic pancreatic adenocarcinoma in Asian patients: Subgroup analysis of the NAPOLI-1 study

Yung Jue Bang, Chung Pin Li, Kyung Hun Lee, Chang Fang Chiu, Joon Oh Park, Yan Shen Shan, Jun Suk Kim, Jen Shi Chen, Hyun Jeong Shim, Kun Ming Rau, Hye Jin Choi, Do Youn Oh, Bruce Belanger, Li Tzong Chen

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Abstract

The global, randomized NAPOLI-1 phase 3 trial reported a survival benefit with liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (nal-IRI+5-FU/LV) in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) after previous gemcitabine-based therapy. Median overall survival (OS) with nal-IRI+5-FU/LV was 6.1 vs 4.2 months with 5-FU/LV alone (unstratified hazard ratio [HR] = 0.67, P =.012). Herein, we report efficacy and safety results from a post-hoc subgroup analysis of Asian patients treated at Asian centers. Primary study endpoint was OS; secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. Patients receiving nal-IRI+5-FU/LV (n = 34) had significantly longer median OS versus 5-FU/LV (n = 35) (8.9 vs 3.7 months; unstratified HR = 0.51, P =.025). Patients had significantly increased median PFS with nal-IRI+5-FU/LV versus 5-FU/LV (4.0 vs 1.4; unstratified HR = 0.48, P =.011), and increased ORR (8.8% vs 0; P =.114). nal-IRI monotherapy (n = 50) numerically improved efficacy endpoints versus 5-FU/LV (n = 48): median OS was 5.8 versus 4.3 months (HR = 0.83, P =.423) and median PFS was 2.8 versus 1.4 months (HR = 0.69, P =.155). Grade ≥3 neutropenia was reported more frequently with nal-IRI+5-FU/LV versus 5-FU/LV (54.5% vs 3.4%), and incidence of grade ≥3 diarrhea was comparable between the two arms (3.0% vs 6.9%). This subgroup analysis confirms nal-IRI+5-FU/LV as an efficacious treatment option that improves survival in Asian patients with mPDAC that progressed after gemcitabine-based therapy, with a safety profile agreeing with previous findings. The nal-IRI+5-FU/LV regimen should represent a new standard of care for these patients in Asia. (Clinicaltrials.gov: NCT01494506).

Original languageEnglish
Pages (from-to)513-527
Number of pages15
JournalCancer Science
Volume111
Issue number2
DOIs
Publication statusPublished - 2020 Feb 1

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All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Bang, Y. J., Li, C. P., Lee, K. H., Chiu, C. F., Park, J. O., Shan, Y. S., Kim, J. S., Chen, J. S., Shim, H. J., Rau, K. M., Choi, H. J., Oh, D. Y., Belanger, B., & Chen, L. T. (2020). Liposomal irinotecan in metastatic pancreatic adenocarcinoma in Asian patients: Subgroup analysis of the NAPOLI-1 study. Cancer Science, 111(2), 513-527. https://doi.org/10.1111/cas.14264