The CCTG PA.7 phase II trial of gemcitabine and nab-paclitaxel with or without durvalumab and tremelimumab as initial therapy in metastatic pancreatic ductal adenocarcinoma.
Daniel J RenoufJonathan M LoreeJennifer J KnoxJames T TophamPetr KavanDerek JonkerStephen WelchFelix CoutureFrederic LemayMustapha TehfeMohammed HarbNathalie AucoinYoo-Joung KoPatricia A TangRavi RamjeesinghBrandon M MeyersChristina A KimPan DuShidong JiaDavid F SchaefferSharlene GillDongsheng TuChris J O'CallaghanPublished in: Nature communications (2022)
Immunotherapy-based monotherapy treatment in metastatic pancreatic ductal adenocarcinoma (mPDAC) has shown limited benefit outside of the mismatch repair deficiency setting, while safety and efficacy of combining dual-checkpoint inhibitor immunotherapy with chemotherapy remains uncertain. Here, we present results from the CCTG PA.7 study (NCT02879318), a randomized phase II trial comparing gemcitabine and nab-paclitaxel with and without immune checkpoint inhibitors durvalumab and tremelimumab in 180 patients with mPDAC. The primary endpoint was overall survival. Secondary endpoints included progression-free survival and objective response rate. Results of the trial were negative as combination immunotherapy did not improve survival among the unselected patient population (p = 0.72) and toxicity was limited to elevation of lymphocytes in the combination immunotherapy group (p = 0.02). Exploratory baseline circulating tumor DNA (ctDNA) sequencing revealed increased survival for patients with KRAS wildtype tumors in both the combination immunotherapy (p = 0.001) and chemotherapy (p = 0.004) groups. These data support the utility of ctDNA analysis in PDAC and the prognostic value of ctDNA-based KRAS mutation status.
Keyphrases
- circulating tumor
- free survival
- cell free
- circulating tumor cells
- locally advanced
- squamous cell carcinoma
- small cell lung cancer
- open label
- single cell
- dna damage
- case report
- advanced non small cell lung cancer
- study protocol
- chemotherapy induced
- rectal cancer
- phase iii
- cell cycle
- big data
- phase ii
- single molecule
- artificial intelligence
- cell proliferation
- epidermal growth factor receptor