Onivyde ONIVYDE contains Irinotecan encapsulated in a pegylated liposomal formulation (liposome injection). Irinotecan is a derivative of camptothecin that acts as a topoisomerase I inhibitor. Its active metabolite, SN-38, binds to the topoisomerase I-DNA complex, preventing religation of single-strand breaks and causing double-strand DNA damage that induces cell apoptosis. The pegylated liposomal encapsulation extends systemic circulation time and enhances drug accumulation within tumor tissue. It is indicated, in combination with oxaliplatin, fluorouracil, and leucovorin (NALIRIFOX), or with fluorouracil and leucovorin alone, for the treatment of adult patients with metastatic pancreatic adenocarcinoma.