Reema A. Patel, MD, associate program director, Hematology & Medical Oncology Fellowship, assistant professor of medicine, Division of Medical Oncology, University of Kentucky, discusses the results of a subgroup analysis from the NAPOLI-1 trial in pancreatic cancer. 

The phase 3 NAPOLI-1 trial demonstrated a survival benefit with liposomal irinotecan (Onivyde) in combination with 5-fluorouracil (5-FU) and leucovorin versus 5-FU and leucovorin alone in patients with metastatic pancreatic ductal adenocarcinoma who had received prior gemcitabine-based therapy. 

A post-hoc subgroup analysis revealed that the majority of patient subgroups responded well to the treatment, Patel explains. However, patients who received prior non-liposomal irinotecan had poorer outcomes versus patients who had no prior irinotecan. Notably, due to the low number of patients who had prior non-liposomal irinotecan, these findings may not be widely applicable in the real-world setting, Patel says. 

However, in practice, it may be optimal to give an alternative therapy between non-liposomal irinotecan and liposomal irinotecan to potentially increase the chance of response to liposomal irinotecan, concludes Patel.

Videos

Reema A. Patel, MD, discusses the results of a subgroup analysis from the NAPOLI-1 trial in pancreatic cancer.  



Dr. Patel on a Subgroup Analysis of the NAPOLI-1 Trial in Pancreatic Cancer 

Reema A. Patel, MD, associate program director, Hematology & Medical Oncology Fellowship, assistant professor of medicine, Division of Medical Oncology, University of Kentucky, discusses ongoing research efforts in pancreatic cancer.

Historically, pancreatic cancer has been associated with dismal outcomes due to limited treatment options. However, novel treatment approaches are being explored, including some that have been successful in treating other tumor types, explains Patel. As such, the field is hopeful that these novel therapies will be emerge in the treatment paradigm, such as having to determine an optimal sequencing strategy, Patel adds.

A similar paradigm shift was observed in hepatocellular carcinoma (HCC), says Patel. Sorafenib (Nexavar) was one of the only treatment options in HCC a decade ago. However, the space is now crowded and complex among novel treatment options, explains Patel. As such, the field is hopeful that a similar shift may be experienced in pancreatic cancer, Patel concludes.

Reema A. Patel, MD, discusses ongoing research efforts in pancreatic cancer.








Dr. Patel Ongoing Research Efforts in Pancreatic Cancer 

Reema A. Patel, MD, associate program director, Hematology & Medical Oncology Fellowship, assistant professor of medicine, Division of Medical Oncology, University of Kentucky, discusses findings from the NAPOLI-1 trial in pancreatic cancer.

 The open-label, randomized, phase 3 NAPOLI-1 trial evaluated nanoliposomal irinotecan (Onivyde) with or without 5-fluorouracil (5-FU) and leucovorin versus 5-FU and leucovorin in patients with metastatic pancreatic cancer who progressed on prior gemcitabine-based therapy, Patel says.

 Results of the study showed that patients who were heavily pretreated with chemotherapy could benefit from the combination of nanoliposomal irinotecan plus 5-FU/leucovorin. Notably, an overall survival benefit was observed with the combination and the progression-free survival (PFS) was doubled compared with chemotherapy alone.

In pancreatic cancer, an improvement in PFS is clinically meaningful, even if it’s only a small amount. The results of NAPOLI-1 showed a 45% reduction in the risk of progression. This regimen is now being evaluated in combination with oxaliplatin as frontline therapy in the ongoing NAPOLI-3 trial, Patel concludes.

Reema A. Patel, MD, discusses findings from the NAPOLI-1 trial in pancreatic cancer.

Dr. Patel on Findings From the NAPOLI-1 Trial in Pancreatic Cancer 

Reema A. Patel, MD, associate program director, Hematology & Medical Oncology Fellowship, assistant professor of medicine, Division of Medical Oncology, University of Kentucky, discusses limitations with chemotherapy in pancreatic cancer.

Pancreatic cancer is a complex and challenging disease to manage for many reasons, Patel says.

Although chemotherapies are effective treatments in many other tumor types, oftentimes, pancreatic cancer is resistant to this course of therapy, Patel explains.

As such, liposomal irinotecan (Onivyde) is an effective and commonly used second-line option for patients with pancreatic cancer, Patel says. Moreover, the therapy appears to elicit better responses compared with conventional chemotherapy.

Furthermore, genetic predispositions and tolerance levels can also prevent many patients with pancreatic cancer from receiving chemotherapy, Patel concludes.

Reema A. Patel, MD,  discusses limitations with chemotherapy in pancreatic cancer.

Reema A. Patel, MD

Articles

Dr. Patel on a Subgroup Analysis of the NAPOLI-1 Trial in Pancreatic Cancer

Dr. Patel Ongoing Research Efforts in Pancreatic Cancer

Dr. Patel on Findings From the NAPOLI-1 Trial in Pancreatic Cancer

Dr. Patel on Limitations With Chemotherapy in Pancreatic Cancer