Promising results for chemo immunotherapy combination against pancreatic cancer
Penn Medicine researchers find a combination of chemotherapy with an immunotherapy meant to unleash the anticancer capacity of the immune system is effective against pancreatic cancer.
A combination of chemotherapy with an immunotherapy meant to unleash the anticancer capacity of the immune system is effective against one of the hardest targets in cancer care, pancreatic cancer, in a national, randomized clinical trial led by researchers at the Perelman School of Medicine, and sponsored by the Parker Institute for Cancer Immunotherapy.
The results of the small but promising trial are published in Nature Medicine.
The researchers have found that in 34 patients with advanced pancreatic cancer randomized to receive the immunotherapy nivolumab with two chemotherapy drugs, nab-paclitaxel and gemcitabine, had a one-year survival rate of 57.7%, significantly greater than the historical average of 35% with chemotherapy alone. The findings also include the identification of immune system biomarkers associated with better outcomes. A second treatment of the immunotherapy sotigalimab with chemotherapy also appears more effective in a subgroup of patients, identified with a different set of biomarkers.
“This study suggests there is benefit of combining immunotherapy and chemotherapy in patients with advanced pancreatic cancer and there may be ways to fine tune treatment choices based on the ‘immune health’ of the patient,” says Robert H. Vonderheide, the John H. Glick Abramson Cancer Center Professor and director of the Abramson Cancer Center at Penn. “We now hope to evaluate these potential biomarkers in further trials to see if they’ll enable us reliably to identify patients who will respond best to this and other combination therapies. The most promising biomarkers were measured by a blood test of the immune system, not genetic sequencing, which opens the door for a new approach in precision oncology.”
The most common form of pancreatic cancer, known as pancreatic ductal adenocarcinoma (PDAC), is commonly diagnosed only after it has become advanced or metastatic, and is also notoriously aggressive and difficult to treat effectively.
Standard chemotherapy regimens can arrest the growth of PDAC tumors, but only temporarily. Newer immune-targeted therapies, such as checkpoint blockade antibodies, have been strikingly effective against some other cancers, but almost entirely ineffective—when used on their own—against PDAC.
However, a ray of hope has come from preclinical experiments of PDAC, and an initial small clinical trial reported by Vonderheide’s team last year suggested that the addition of chemotherapy can substantially disrupt pancreatic tumors’ resistance to immunotherapy—making the combination more effective than either type of treatment on its own. In the new study, they tested that approach on a larger scale.
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