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Irinotecan liposome + capecitabine is a combination chemotherapy regimen consisting of liposomal irinotecan (nal-IRI) and oral capecitabine. This combination is being investigated primarily for the treatment of advanced pancreatic cancer, particularly as a second-line treatment option for patients who have progressed after previous therapy. Irinotecan liposome (Onivyde) is a topoisomerase 1 inhibitor encapsulated within a lipid bilayer vesicle. The liposomal formulation extends plasma levels of irinotecan and prolongs exposure of its active metabolite SN-38, leading to increased antitumor activity compared to conventional irinotecan. Topoisomerase 1 relieves torsional strain in DNA by inducing single-strand breaks. Irinotecan and SN-38 bind reversibly to the topoisomerase 1-DNA complex and prevent re-ligation of these breaks, leading to double-strand DNA damage and cell death. Capecitabine is an oral prodrug of 5-fluorouracil (5-FU), which is converted to 5-FU in the body. This combination aims to improve patient convenience while maintaining efficacy by replacing continuous infusion of 5-FU (as used in the NAPOLI regimen) with oral capecitabine.
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