{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:48:15Z","timestamp":1790624895628,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"21","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pivotal clinical trials supported survival benefits of liposomal irinotecan (nal\u2010IRI) plus fluorouracil\/leucovorin in patients with pancreatic ductal adenocarcinoma (PDAC) who previously received gemcitabine\u2010based therapy. There are concerns about the benefits of nal\u2010IRI in patients who received FOLFIRINOX (combined fluorouracil, leucovorin, IRI, and oxaliplatin) because of potential cross\u2010resistance to IRI. The objective of this meta\u2010analysis was to characterize the impact of the previous receipt of IRI on the outcomes of nal\u2010IRI regimens in patients with advanced PDAC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Real\u2010world studies evaluating the outcomes of nal\u2010IRI in patients who had prior IRI exposure published up to April 2023 were searched using electronic databases. The meta\u2010analysis was conducted using a random effects model to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a01368 patients) were included. The pooled median progression\u2010free survival (PFS) was 2.02 months (95% CI, 1.43\u20132.57 months), and the median overall survival (OS) was 4.26 months (95% CI, 3.03\u20135.39 months). Patients with prior IRI exposure had PFS (HR, 1.17; 95% CI, 0.94\u20131.47; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.17) and OS (HR, 1.16; 95% CI, 0.95\u20131.42; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.16) comparable to patients without prior IRI exposure. Likewise, patients who had progressive disease on conventional IRI had PFS (HR, 1.50; 95% CI, 0.73\u20133.08; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.24) and OS (HR, 1.70; 95% CI, 0.68\u20134.27; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.26) with nal\u2010IRI comparable to patients who had no progressive disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prior IRI exposure does not affect the survival outcomes of nal\u2010IRI regimens in patients who have advanced PDAC. The selection of later lines of chemotherapy regimens should be based on the differential safety profile, patient status, the cost of treatment, and health\u2010related quality of life.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35479","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T13:50:51Z","timestamp":1720619451000},"page":"3734-3744","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical outcomes of liposomal irinotecan in patients with advanced pancreatic cancer previously treated with conventional irinotecan: A meta\u2010analysis of real\u2010world evidence"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8307-4192","authenticated-orcid":false,"given":"Amol","family":"Gupta","sequence":"first","affiliation":[{"name":"The Sidney Kimmel Comprehensive Cancer Center The Johns Hopkins Hospital  Baltimore Maryland 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