A randomised phase 2 study of liposomal irinotecan in combination with 5-fluorouracil/leucovorin and oxalipalatin versus nab-paclitaxel plus gemcitabine in unresectable locally advanced or metastatic pancreatic cancer.
Authors: Chuntao Gao, Xingyun Chen, Jihui Hao, Yanqiao Zhang, Xiujuan Qu, Jingdong Zhang, Heshui Wu, Meili Sun, Yong Zha, Junbin Wang, Yusheng Wang, Zhihua Li, Ying Cheng, Yanping Liu, Niu Miao, Yijiao Xie
Journal: Journal of Clinical Oncology (2024)

4141 Background: FOLFIRINOX remained as first-line standard of care. However, FOLFIRINOX often requires dose modifications, delays and growth factor support due to excessive toxicity which can complicate care delivery. Liposomal irinotecan (HE072) is a liposomal formulation that encapsulates irinotecan in a lipid bilayer vesicle, as a generic drug, had been approved for marketing in China on September 15, 2022, and was used in combination with 5-fluorouracil (5-FU) and leucovorin for patients with metastatic pancreatic cancer who progressed after receiving gemcitabine treatment. This study aims to compare with nab-paclitaxel+gemcitabine (AG), which is another first-line stand of care, through substitute HE072 for traditional irinotecan in the standard FOLFIRINOX regimen (NALIRIFOX) and to demonstrate safe and effective delivery. Methods: HE072-CSP-004 was a randomised, open-label, multi-center, phase 2 study. Patients with unresectable locally advanced or metastatic pancreatic cancer were randomly assigned (2:1) to receive NALIRIFOX (HE072 50 mg/m², oxaliplatin 60 mg/m², leucovorin 400 mg/m², and fluorouracil 2400 mg/m², administered sequentially as a continuous intravenous infusion over 46 h) on days 1 and 15 of a 28-day cycle or AG (nab-paclitaxel 125 mg/m² and gemcitabine 1000 mg/m²), administered intravenously, on days 1, 8, and 15 of a 28-day cycle. Other key eligibility criteria include ECOG performance status of 0 to 1, untreated with systematic anti-tumor regimens; Primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), overall survival (OS), disease control rate (DCR), and duration of response (DOR). Results: As of Dec 12, 2023, 117 patients were randomly assigned (NALIRIFOX, 78; AG, 39). The two groups were comparable on baseline characteristics. The median PFS differences was statistically significant as 7.6 months (95%CI 5.49-9.17) with NALIRIFOX versus 3.7 months (95%CI 3.15-5.06) with AG (hazard ratio 0.55; 95% CI 0.34-0.87; p=0.0104). Median OS was 13.4 months (95%CI 9.89-NE) with NALIRIFOX versus 8.8 months (95%CI 6.87-12.16) with AG (hazard ratio 0.66; 95% CI 0.39-1.11; p=0.1125). Grade 3 or higher treatment-emergent adverse events (TRAE) occurred in 52 (66.7%) of 78 patients receiving NALIRIFOX and 30 (76.9%) of 39 patients receiving AG. No new safety signal was observed. Conclusions: The study met the primary endpoint of PFS demonstrating statistically significant and clinically meaningful improvements in PFS and with a trend of OS benefit for NALIRIFOX over AG. The safety profile was consistent with the known risks of the individual toxicity. This study is consistent with the existing NAPOLI 3 study. Clinical trial information: NCT05047991 .