Irinotecan Liposome — Drug Monograph

Brand names: Onivyde

Drug class: Topoisomerase Inhibitor

Mechanism of Action

Irinotecan liposome is a nanoparticle formulation of irinotecan designed for extended circulation and enhanced intratumoral delivery. Irinotecan and its active metabolite, SN-38, bind to the topoisomerase I-DNA complex, preventing the re-ligation of single-strand DNA breaks. This results in double-strand DNA damage and cell death during the S-phase of the cell cycle. The liposomal encapsulation protects irinotecan from premature hydrolysis and facilitates higher SN-38 concentrations within the tumor microenvironment through the enhanced permeability and retention (EPR) effect.

FDA Indications

• In combination with oxaliplatin, fluorouracil, and leucovorin, for the first-line treatment of adult patients with metastatic pancreatic adenocarcinoma
• In combination with fluorouracil and leucovorin, for the treatment of adult patients with metastatic adenocarcinoma of the pancreas after disease progression following gemcitabine-based therapy

Common Side Effects

• Diarrhea
• Fatigue
• Vomiting
• Nausea
• Decreased appetite
• Stomatitis
• Pyrexia
• Neutropenia
• Anemia
• Thrombocytopenia

Clinical Pearl

Onivyde is NOT interchangeable with conventional irinotecan; the liposomal formulation significantly alters the pharmacokinetics, providing higher SN-38 exposure in the tumor. It is specifically approved for metastatic pancreatic cancer, a setting where conventional irinotecan is often used but the liposomal version has demonstrated specific survival benefits in combination regimens. As with all irinotecan products, "I run to the can" (diarrhea management) is the primary counseling point for…

Related Therapies & Mechanisms

• Etoposide (VePesid) — Topoisomerase Inhibitor
• Irinotecan (Camptosar) — Topoisomerase Inhibitor
• Mitoxantrone (Novantrone) — Topoisomerase Inhibitor
• Topotecan (Hycamtin) — Topoisomerase Inhibitor