Nalirifox

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 28, 2024.

What is NALIRIFOX?

Nalirifox is a chemotherapy regimen that consists of 4 different medicines, 3 of which are chemotherapy agents and one is similar to folic acid:

• Onivyde (irinotecan liposomal), a chemotherapy agent encapsulated in a liposomal base to allow for more sustained blood levels of irinotecan 
• Oxaliplatin, another chemotherapy medicine that is a platinum-based alkylating agent that forms cross-links in DNA
• Fluorouracil, an antimetabolite chemotherapy treatment that disrupts the formation of DNA
• Leucovorin is a medicine similar to folic acid that is used to protect healthy cells from the side effects of chemotherapy agents.

Nalifrifox may be used as a first-line treatment for pancreatic cancer that has spread (metastatic pancreatic cancer). 

NALIRIFOX vs FOLFIRINOX

The difference between Nalirifox and Folfirinox is the type of irinotecan they contain. Nalirifox contains:

• Irinotecan liposomal (Onivyde)
• Oxaliplatin
• Fluorouracil
• Leucovorin

Folfirinox contains:

• Irinotecan (unencapsulated)
• Oxaliplatin
• Fluorouracil
• Leucovorin.

The only difference between Nalirifox and Folfirinox is the formulation of irinotecan used.

• In Nalirifox, the irinotecan has been encapsulated which allows it to remain in circulation for longer than unencapsulated irinotecan before it is converted to its active metabolite SN-38.
• Research has shown irinotecan liposomal demonstrates higher and more sustained levels of irinotecan and SN-38 compared with free irinotecan. In Folfirinox, the irinotecan is unencapsulated.

There have been no head-to-head comparison trials between Nalirifox and Folfirinox.

An informal cost analysis suggests irinotecan liposomal is approximately 67 times more expensive than unencapsulated irinotecan in the United States.

What studies have been done using Nalirifox?

The NAPOLI 3 trial was a randomized, open-label, phase 3 trial that compared Nalirifox to nab-paclitaxel and gemcitabine in patients with metastatic pancreatic ductal adenocarcinoma who had not yet received any treatment.

• 383 patients received Nalirifox and 387 received nab-paclitaxel plus gemcitabine.
• The median follow-up was 16.1 months.
• The median overall survival (OS) was 11.1 months (95% confidence interval [CI] 10.0–12.1) with Nalirifox versus 9.2 months (95% CI 8.3-10.6) with nab-paclitaxel plus gemcitabine (hazard ratio 0.83, 95% CI 0.70-0.99; p = 0.036).
• This was considered a statistically significant finding and represented an overall difference in survival of 1.9 months.
• Treatment-related deaths occurred in 6 (2%) patients in the Nalirifox group and 8 (2%) patients in the nab-paclitaxel–gemcitabine group.
• The study was funded by Ipsen.

See also

• Breast Cancer Guide: Causes, Symptoms & Diagnosis
• Breast Cancer: Treatment and Prevention Options
• Cancer
• Mesothelioma
• Prostate Cancer

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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