Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 11Neutropenia and diarrhea associated with nal-IRI
2:14 minutes.
TRANSCRIPTION:
DR LOVE: What’s the basis for the black box warning on neutropenia and diarrhea? DR BEKAII-SAAB: These are irinotecan toxicities. And again, just you have to keep in mind that a lot of patients on that study were included and X-US, where again, there is less good supportive management in some ways. But the toxicities are about the same, that with irinotecan. DR LOVE: So clinically if you have a patient that you’re about to start on this agent, what do you say to them to expect, or what are you expecting to see? In terms of toxicity. DR BEKAII-SAAB: In terms of toxicities, exactly what you would expect with irinotecan. Diarrhea at a rate of 10% to 12% for Grade 3 and 4, levels of neutropenia usually transient. There are some small — 3% or 4% febrile neutropenia, which is what you would expect again with irinotecan combined to 5-FU, so really not much different than my discussion with a patient with FOLFIRI. DR LOVE: So Margaret, agree, disagree or in between with everything he just said? DR TEMPERO: I hate to disagree with my good friend Tony, but I actually do think that the — and he may know the data better than I do, too — but that the toxicity profile with liposomal irinotecan in combination with 5-FU and leucovorin seems to be a little better in terms of the diarrhea. Patients get cramping, but I don’t feel that they get as much diarrhea or quick-onset diarrhea. So that is maybe a little bit different. The drug was developed at UCSF, so we had the privilege of doing a lot of the early work with the drug and doing the first Phase II with the drug. So we’ve had a sense of its value for quite a while. DR LOVE: What kind of sense of value do you have in terms of efficacy? Have you seen patients that you thought benefited? DR TEMPERO: We’re only starting to just use it in combination with 5-FU and leucovorin. And certainly we’ve seen some benefit, but I don’t have the aggregate experience yet to kind of give a sense of whether I think it would be any better than FOLFIRI, for example. |