{"entity":{"id":"irinotecan","kind":"drug","name":"Irinotecan (and liposomal irinotecan)","aka":[],"tldr":"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.","status":"approved","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Irinotecan","links":[{"label":"Label (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=irinotecan"}],"tags":["gap-fill","generic","who-essential"],"related":["st-johns-wort-interaction"],"cancers":["colorectal","pancreatic","ewing-sarcoma","rhabdomyosarcoma","neuroblastoma","sclc","medulloblastoma"],"sections":[],"technologies":["topoisomerase-inhibitors","cytotoxic-chemotherapy"],"targets":[],"drugs":[],"companies":["pfizer","ipsen","merrimack-pharmaceuticals"],"institutions":[],"pathways":[],"terms":["payload"],"trials":["nct06219941","nct04657068","nct05592626","nct07356973","nct04725994","swog-s1406","avf2107g"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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":[{"region":"US","year":1996,"indication":"Metastatic colorectal cancer after 5-FU; first line with 5-FU/LV 2000"},{"region":"US","year":2015,"indication":"Liposomal irinotecan with 5-FU/LV in metastatic pancreatic cancer after gemcitabine"},{"region":"US","year":2024,"indication":"Liposomal irinotecan in NALIRIFOX first-line metastatic pancreatic cancer"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[{"date":"1996-06-14","type":"accelerated-approval","region":"US","note":"Accelerated approval on a surrogate endpoint, with a confirmatory trial required.","indication":"Metastatic colon or rectal carcinoma that progressed following 5-FU therapy"},{"date":"1998-10-22","type":"conversion","region":"US","note":"Confirmed: the accelerated approval of 1996 converted to traditional approval 2.4 years after it was granted.","indication":"Metastatic colon or rectal carcinoma that progressed following 5-FU therapy"}]},"route":"/drugs/irinotecan/","neighbours":{"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"dietary-supplements-treatment-interactions","kind":"technology","name":"Dietary supplements during cancer treatment: interactions and harms","route":"/technologies/dietary-supplements-treatment-interactions/"},{"id":"oncology-pharmacogenomics","kind":"technology","name":"Pharmacogenomic testing before chemotherapy","route":"/technologies/oncology-pharmacogenomics/"},{"id":"st-johns-wort-interaction","kind":"technology","name":"St John's wort: an interaction to avoid","route":"/technologies/st-johns-wort-interaction/"},{"id":"topoisomerase-inhibitors","kind":"technology","name":"Topoisomerase-I inhibitors (and ADC payloads)","route":"/technologies/topoisomerase-inhibitors/"},{"id":"ugt1a1-genotyping","kind":"technology","name":"UGT1A1 genotyping before irinotecan","route":"/technologies/ugt1a1-genotyping/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"ewing-sarcoma","kind":"cancer","name":"Ewing sarcoma","route":"/cancers/ewing-sarcoma/"},{"id":"medulloblastoma-group-3-4","kind":"cancer","name":"Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)","route":"/cancers/medulloblastoma-group-3-4/"},{"id":"hepatoblastoma","kind":"cancer","name":"Hepatoblastoma","route":"/cancers/hepatoblastoma/"},{"id":"neuroblastoma-high-risk","kind":"cancer","name":"High-risk neuroblastoma","route":"/cancers/neuroblastoma-high-risk/"},{"id":"medulloblastoma","kind":"cancer","name":"Medulloblastoma","route":"/cancers/medulloblastoma/"},{"id":"metastatic-pdac","kind":"cancer","name":"Metastatic pancreatic ductal adenocarcinoma","route":"/cancers/metastatic-pdac/"},{"id":"neuroblastoma","kind":"cancer","name":"Neuroblastoma (paediatric)","route":"/cancers/neuroblastoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"rhabdomyosarcoma","kind":"cancer","name":"Rhabdomyosarcoma","route":"/cancers/rhabdomyosarcoma/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"company":[{"id":"ipsen","kind":"company","name":"Ipsen","route":"/companies/ipsen/"},{"id":"merrimack-pharmaceuticals","kind":"company","name":"Merrimack Pharmaceuticals","route":"/companies/merrimack-pharmaceuticals/"},{"id":"pfizer","kind":"company","name":"Pfizer (incl. 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