Kipps Emma, Young Kate, Starling Naureen
Royal Marsden NHS Foundation Trust Ringgold standard institution - Department of Gastrointestinal Oncology, London, UK.
Ther Adv Med Oncol. 2017 Mar;9(3):159-170. doi: 10.1177/1758834016688816. Epub 2017 Mar 1.
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. The majority of patients are diagnosed with locally advanced or metastatic disease with a prognosis of short months. Therapeutic options are limited and until recently, there was no standard second-line chemotherapy option. Liposomal constructs have been engineered to encapsulate chemotherapy thereby preventing premature metabolism, improving distribution and minimizing toxicity. Favourable preclinical data on liposomal irinotecan and early phase trials, led to a recently published phase III trial of liposomal irinotecan in combination with fluorouracil and folinic acid in patients with metastatic PDAC, who progressed after gemcitabine-based chemotherapy. As a direct result, the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA) have approved the use of liposomal irinotecan in this setting. However, first-line treatment options for this disease now include the combination regimen, FOLFIRINOX, in patients with good performance status, and the role of second-line combination treatment with liposomal irinotecan in this setting is unclear. Recent advances have changed the therapeutic landscape, as clinicians are now able to choose a sequential approach to treatment tailored to the individual patient characteristics. This article reviews current treatment options for metastatic PDAC and focuses on the efficacy, safety and place in therapy of liposomal irinotecan.
胰腺导管腺癌（PDAC）是一种致命疾病。大多数患者被诊断为局部晚期或转移性疾病，预后仅数月。治疗选择有限，直到最近，都没有标准的二线化疗方案。脂质体构建体已被设计用于包裹化疗药物，从而防止过早代谢、改善分布并将毒性降至最低。脂质体伊立替康的临床前数据良好以及早期试验，促成了最近一项脂质体伊立替康联合氟尿嘧啶和亚叶酸用于转移性PDAC患者的III期试验的发表，这些患者在基于吉西他滨的化疗后病情进展。直接结果是，美国食品药品监督管理局（FDA）和欧洲药品管理局（EMA）已批准在这种情况下使用脂质体伊立替康。然而，该疾病的一线治疗选择现在包括适用于身体状况良好患者的联合方案FOLFIRINOX，而脂质体伊立替康在这种情况下二线联合治疗的作用尚不清楚。最近的进展改变了治疗格局，因为临床医生现在能够根据个体患者特征选择量身定制的序贯治疗方法。本文综述了转移性PDAC的当前治疗选择，并重点关注脂质体伊立替康的疗效、安全性及在治疗中的地位。
