Onivyde also known as MM-398 or PEP02, is a liposomal nanoformulation of irinotecan which was approved by the FDA in 2015 for treatment of metastatic pancreatic cancer. FOLFIRINOX is a chemotherapeutic regimen used for advanced pancreatic cancer consisting of (irinotecan, 5-fluorouracil, oxaliplatin and folinic acid) which showed a survival improvement in patients compared with gemcitabine administration. However, there are still some negative effects of Onivyde including diarrhea, vomiting, abdominal pain and alopecia. Onivyde pegylated liposomal is available for infusion (drip) into a vein. The dose is calculated on the basis of the patient’s weight and height and is given every 2 weeks together with fluorouracil and leucovorin. The doctor may reduce the dose in patients who develop severe side effects and in those with particular genetic characteristics that increase the risk of side effects. Nanoliposomal formulations have improved circulation time, passive tumor targeting, and fewer side effects due to tumor overexpression.