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Irinotecan liposome in combination with fluorouracil and leucovorin is a pharmaceutical regimen used primarily for the treatment of metastatic pancreatic adenocarcinoma. Irinotecan liposome (marketed as Onivyde) is a topoisomerase 1 inhibitor encapsulated in a lipid bilayer vesicle (liposome), which enhances drug delivery to tumors and prolongs systemic exposure. Upon administration, irinotecan is converted to its active metabolite SN-38, which binds reversibly to the topoisomerase 1-DNA complex and prevents re-ligation of single-strand DNA breaks, leading to double-strand DNA damage and cell death. Fluorouracil is an antimetabolite that inhibits thymidylate synthase, disrupting DNA synthesis; leucovorin enhances the binding of fluorouracil to its target enzyme. This combination has demonstrated efficacy as first-line therapy for metastatic pancreatic cancer (in combination with oxaliplatin) and as second-line therapy after gemcitabine-based regimens[1][3][4][5][6].
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