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NH002 + nanoliposomal irinotecan + leucovorin + 5-fluorouracil is a combination chemo-sonodynamic therapy regimen being evaluated by National Taiwan University Hospital for the treatment of metastatic pancreatic ductal adenocarcinoma (PDAC) with liver metastasis. The regimen utilizes NH002, a perflutren lipid microsphere injectable suspension, as a microbubble agent to facilitate sonoporation. When targeted ultrasound is applied to liver metastases using the Aco Apache Ultrasound system, the NH002 microbubbles undergo cavitation, which temporarily increases the permeability of the tumor's microvasculature and cell membranes. This physical disruption is designed to enhance the delivery and accumulation of the co-administered chemotherapy—nanoliposomal irinotecan (Onivyde), leucovorin, and 5-fluorouracil (5-FU)—within the metastatic lesions. The cytotoxic mechanism involves the inhibition of DNA topoisomerase I by irinotecan's active metabolite and the inhibition of thymidylate synthase by 5-FU, leading to impaired DNA synthesis and tumor cell apoptosis. This approach specifically targets gemcitabine-refractory patients to improve therapeutic outcomes in advanced pancreatic cancer.
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