Real-world outcomes associated with liposomal irinotecan dose reductions in metastatic pancreatic ductal adenocarcinoma

Lay abstract Liposomal irinotecan + 5-fluorouracil/leucovorin is an approved treatment regimen for patients with metastatic pancreatic cancer following progression after gemcitabine-based therapy. Patients may not be able to tolerate the recommended full dosage of liposomal irinotecan due to toxicities and their physicians may choose to reduce the dosage in order to continue treatment. The authors examined 320 patients treated with liposomal irinotecan-based regimens. About a quarter of the patients had their dose reduced. The data suggest that dose reductions were an effective strategy to keep patients on treatment and improve clinical outcomes. Aim:This study sought to understand the association between liposomal irinotecan dose reductions (DRs) and clinical outcomes among patients with metastatic pancreatic ductal adenocarcinoma.Materials & methods:A retrospective study of adult patients with metastatic pancreatic ductal adenocarcinoma treated with liposomal irinotecan in the Flatiron Health database was conducted to assess treatment and clinical outcomes.Results:DRs occurred in 28.4% of the 320 patients in the study. Patients with DRs had longer overall survival (7.7 [95% CI: 6.2-10.2]) vs 3.6 [3.2-4.1] months) and time to discontinuation (4.2 [3.0-4.9] vs 1.4 [1.0-1.5] months) than patients without DRs. Results were consistent in a validation analysis requiring three cycles of treatment.Conclusion:Liposomal irinotecan DRs were associated with improved clinical outcomes compared with patients without DRs.