The impact of starting dose with or without subsequent dose escalation of liposomal irinotecan on treatment outcomes in patients with metastatic pancreatic ductal adenocarcinoma

• Published in: American journal of cancer research 2022, Vol.12 (11), p.5062-5073
• Main Authors: Chiang, Nai-Jung, Shan, Yan-Shen, Li, Chung-Pin, Yang, Shih-Hung, Su, Yung-Yeh, Chiu, Sz-Chi, Bai, Li-Yuan, Chuang, Shih-Chang, Chan, De-Chuan, Yen, Chia-Jui, Peng, Cheng-Ming, Chiu, Tai-Jan, Chen, Yen-Yang, Chen, Jen-Shi, Chou, Wen-Chi
• Format: Article
• Language: English
• ISSN: 2156-6976; 2156-6976

Liposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (5-FU/LV) improves survival in patients with pancreatic ductal adenocarcinoma (PDAC) after progression to gemcitabine-based therapy. Few studies have examined whether the starting dose and dose escalation of nal-IRI in subsequent treatment cycles may influence patient outcomes and toxicity profiles. A total of 667 patients who received nal-IRI + 5-FU/LV for PDAC treatment between August 2018 and November 2020 at nine medical centers in Taiwan were included and retrospectively analyzed. Patients were allocated to the standard starting dose (SD), reduced starting dose (RD) without escalation, and RD with escalation of nal-IRI groups for comparison of survival outcome and safety. Propensity score matching (PSM) was performed to adjust for possible confounding variables. Nal-IRI was prescribed at SD, RD without escalation, and RD with escalation in 465 (69.7%), 147 (22.0), and 55 (8.2%), respectively. RD with escalation patients had significantly longer treatment cycles (6, range 2-25) than SD (5, range 1-42, P