# Irinotecan (and liposomal irinotecan)

Source: https://onco.cc/drugs/irinotecan/  
OnCo record `irinotecan` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Irinotecan is a topoisomerase-blocking chemotherapy central to bowel and pancreatic cancer regimens (FOLFIRI, FOLFIRINOX, NALIRIFOX) and to salvage therapy in childhood sarcomas; it carries the same warhead as the deruxtecan ADC payloads.

## Summary

Approved 1996 (colorectal after 5-FU); FOLFIRI first line with bevacizumab/cetuximab; FOLFIRINOX (2011) and liposomal irinotecan (NAPOLI-1 2015, NAPOLI-3 NALIRIFOX 2024) in pancreatic cancer; irinotecan-temozolomide in Ewing, rhabdomyosarcoma, neuroblastoma; vincristine-irinotecan windows in RMS. Diarrhoea (cholinergic and delayed) and neutropenia; UGT1A1 genotyping is label-recommended.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill; generic; who-essential
- Brand: Camptosar / Onivyde
- Modality: Topoisomerase I inhibitor (camptothecin prodrug)
- Mechanism: Converted by carboxylesterases to SN-38, which traps topoisomerase I-DNA cleavage complexes; UGT1A1*28 slows SN-38 clearance and raises toxicity.
- Approvals: US 1996: Metastatic colorectal cancer after 5-FU; first line with 5-FU/LV 2000; US 2015: Liposomal irinotecan with 5-FU/LV in metastatic pancreatic cancer after gemcitabine; US 2024: Liposomal irinotecan in NALIRIFOX first-line metastatic pancreatic cancer

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Irinotecan
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=irinotecan

## Connected records

- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Dietary supplements during cancer treatment: interactions and harms](https://onco.cc/technologies/dietary-supplements-treatment-interactions/), [Pharmacogenomic testing before chemotherapy](https://onco.cc/technologies/oncology-pharmacogenomics/), [St John's wort: an interaction to avoid](https://onco.cc/technologies/st-johns-wort-interaction/), [Topoisomerase-I inhibitors (and ADC payloads)](https://onco.cc/technologies/topoisomerase-inhibitors/), [UGT1A1 genotyping before irinotecan](https://onco.cc/technologies/ugt1a1-genotyping/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Ewing sarcoma](https://onco.cc/cancers/ewing-sarcoma/), [Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)](https://onco.cc/cancers/medulloblastoma-group-3-4/), [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/), [High-risk neuroblastoma](https://onco.cc/cancers/neuroblastoma-high-risk/), [Medulloblastoma](https://onco.cc/cancers/medulloblastoma/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Neuroblastoma (paediatric)](https://onco.cc/cancers/neuroblastoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Rhabdomyosarcoma](https://onco.cc/cancers/rhabdomyosarcoma/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- companies: [Ipsen](https://onco.cc/companies/ipsen/), [Merrimack Pharmaceuticals](https://onco.cc/companies/merrimack-pharmaceuticals/), [Pfizer (incl. Seagen)](https://onco.cc/companies/pfizer/)
- terms: [FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX](https://onco.cc/terms/folfox-family/), [FOXO1 fusion status and IRS group (rhabdomyosarcoma)](https://onco.cc/terms/foxo1-fusion-status/), [Immune-mediated colitis and diarrhoea](https://onco.cc/terms/immune-colitis/), [Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies](https://onco.cc/terms/chemotherapy-side-effects-colorectal/), [Payload (ADC)](https://onco.cc/terms/payload/), [SN-38](https://onco.cc/terms/sn-38/)
- trials: [A Clinical Study of Liposomal Irinotecan for Second-Line Therapy in Metastatic Colorectal Cancer](https://onco.cc/trials/nct07585279/), [A Study of a Selective T Cell Receptor (TCR) Targeting, Bifunctional Antibody-fusion Molecule STAR0602 in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05592626/), [A Study of Aflibercept in Combination With FOLFIRI in Patients With Second-Line Metastatic Colorectal Cancer in Japan](https://onco.cc/trials/nct01882868/), [A Study of ART0380 for the Treatment of Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct04657068/), [Alliance N0147](https://onco.cc/trials/n0147/), [ANBL1221](https://onco.cc/trials/anbl1221/), [AVF2107g](https://onco.cc/trials/avf2107g/), [AZD0901 in Participants With Advanced Solid Tumours Expressing Claudin18.2](https://onco.cc/trials/nct06219941/), [BEACON CRC](https://onco.cc/trials/beacon-crc/), [Combination Chemotherapy and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct00628810/), [DESTINY-Gastric01](https://onco.cc/trials/destiny-gastric01/), [FUDR/Oxaliplatin HAI Plus Irinotecan vs. FOLFOXIRI Chemotherapy in Treating Initially Unresectable CRCLM](https://onco.cc/trials/nct03678428/), [G-CSF in Preventing Neutropenia During First-Line Treatment With Chemotherapy and Bevacizumab in Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct00541125/), [Hepatic Arterial Infusion of Liposomal Irinotecan Plus Oxaliplatin and Capecitabine as Adjuvant Therapy for Colorectal Cancer Liver Metastases](https://onco.cc/trials/nct07570914/), [High-dose FOLFIRI in Advanced Colorectal Cancer Patients With Wild-type UGT1A1*6 and *28](https://onco.cc/trials/nct03329183/), [High-Risk Neuroblastoma Study 2 of SIOP-Europa-Neuroblastoma (SIOPEN)](https://onco.cc/trials/nct04221035/), [Irinotecan-ChemoSeed in Surgically Resectable Glioblastoma](https://onco.cc/trials/nct07356973/), [Liposomal Irinotecan and Capecitabine Plus Bevacizumab as Second-line Therapy in Metastatic Colorectal Cancer](https://onco.cc/trials/nct06192680/), [Liposomal Irinotecan and Leucovorin/5-fluorouracil Plus Bevacizumab in Metastatic Colorectal Cancer](https://onco.cc/trials/nct06184698/), [Liposomal Irinotecan With TAS102 and Bevacizumab for Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05854498/), [mFOLFOX/mFOLFIRI vs. mFOLFOX in Advanced or Recurrent Biliary Tract Cancer Second-line](https://onco.cc/trials/nct07062536/), [NORPACT-1](https://onco.cc/trials/norpact-1/), [PETACC-3](https://onco.cc/trials/petacc-3/), [Pressurized Intraperitoneal Aerosolized Chemotherapy With Mitomycin for the Treatment of Unresectable Appendix or Colorectal Cancer With Peritoneal Metastases,](https://onco.cc/trials/nct07271355/), [PRODIGE 23](https://onco.cc/trials/prodige-23/), [PRODIGE 4 / ACCORD 11](https://onco.cc/trials/prodige-4-accord-11/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/), [Short-Course Radiotherapy, Nal-IRI, Capecitabine, and Camrelizumab for Locally Advanced MSS Rectal Cancer](https://onco.cc/trials/nct07521605/), [Sintilimab Plus NALIRIFOX or Gemcitabine-Cisplatin as First-Line Treatment for Metastatic Biliary Tract Cancer](https://onco.cc/trials/nct07831993/), [Study on the Efficacy and Safety of Neoadjuvant Radiotherapy Combined With Tislelizumab, Liposomal Irinotecan, and Capecitabine in the Treatment of pMMR Locally](https://onco.cc/trials/nct07104604/), [Study to Assess the Safety, Tolerability, and Efficacy of IDX-1197 in Combination With XELOX or Irinotecan in Patients With Advanced Gastric Cancer](https://onco.cc/trials/nct04725994/), [SWOG S1406](https://onco.cc/trials/swog-s1406/), [Testing Higher Dose Radiation Therapy for Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct06958328/), [Testing Pump Chemotherapy in Addition to Standard of Care Chemotherapy Versus Standard of Care Chemotherapy Alone for Patients With Unresectable Colorectal Liver Metastases: The PUMP Trial](https://onco.cc/trials/nct05863195/), [TRIBE](https://onco.cc/trials/tribe/), [Tumor Subtypes in Subjects on FOLFIRINOX With Non-Metastatic Pancreatic Cancer](https://onco.cc/trials/nct03977233/), [VELOUR](https://onco.cc/trials/velour/), [Vitamin D3 With Chemotherapy and Bevacizumab in Treating Patients With Advanced or Metastatic Colorectal Cancer](https://onco.cc/trials/nct04094688/)
- key papers: [ANBL1221 expansion: irinotecan, temozolomide and dinutuximab with GM-CSF in refractory or relapsed neuroblastoma](https://onco.cc/key-papers/paper-anbl1221-expansion-dinutuximab-gm-csf-mody-jco-2020/), [ANBL1221: irinotecan-temozolomide with temsirolimus or dinutuximab in relapsed or refractory neuroblastoma](https://onco.cc/key-papers/paper-anbl1221-irinotecan-temozolomide-dinutuximab-mody-lancet-oncol-2017/), [Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer (CRYSTAL)](https://onco.cc/key-papers/paper-van-cutsem-crystal-cetuximab-folfiri-nejm-2009/), [Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)](https://onco.cc/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/), [Encorafenib, binimetinib, and cetuximab in BRAF V600E-mutated colorectal cancer (BEACON CRC)](https://onco.cc/key-papers/paper-kopetz-beacon-encorafenib-braf-colorectal-nejm-2019/), [FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3)](https://onco.cc/key-papers/paper-heinemann-fire-3-cetuximab-vs-bevacizumab-lancet-oncol-2014/), [FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of TRIBE](https://onco.cc/key-papers/paper-cremolini-tribe-folfoxiri-bevacizumab-lancet-oncol-2015/), [Hurwitz 2004: bevacizumab with chemotherapy for metastatic colorectal cancer, the first anti-angiogenic drug to extend life](https://onco.cc/key-papers/paper-hurwitz-bevacizumab-crc-nejm-2004/), [Liposomal irinotecan plus fluorouracil and leucovorin versus fluorouracil and leucovorin for metastatic biliary tract cancer after progression on gemcitabine plus cisplatin (NIFTY): a multicentre, open-label, randomised, phase 2b study](https://onco.cc/key-papers/paper-nifty-liposomal-irinotecan-lancet-oncol-2021/), [Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23)](https://onco.cc/key-papers/paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)
- drugs: [FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan)](https://onco.cc/drugs/folfoxiri/)
- targets: [Topoisomerase I (TOP1)](https://onco.cc/targets/top1/), [UGT1A1](https://onco.cc/targets/ugt1a1/)
- pathways: [DNA replication & origin licensing](https://onco.cc/pathways/dna-replication-licensing/)

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JSON: https://onco.cc/api/v1/entities/irinotecan.json