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For patients with locally advanced pancreatic cancer, there have traditionally been a limited number of treatment options available. Based on the efficacy in the metastatic setting, E. Gabriela Chiorean, MD, suggests that nab-paclitaxel plus gemcitabine or FOLFIRINOX could be administered, in an attempt to downstage the tumor. In some situations, particularly borderline resectable disease, this approach could be successful, Chiorean suggests.
Outside of these regimens, clinical trials are exploring novel therapeutics. A randomized phase IIb study found that the combination of the novel hypoxia-targeted drug TH-302 improved progression-free survival (PFS) when compared to gemcitabine alone for patients with advanced pancreatic cancer. These results led to the formation of a phase III trial investigating the drug with a primary endpoint of overall survival. Francis P. Arena, MD, notes that TH-302 is very active and has demonstrated promising results so far.
The novel hyaluronan inhibitor PEGPH20 will be explored in two upcoming phase II trials for patients with advanced pancreatic cancer, explains Ramesh K. Ramanathan, MD. Earlier phase I studies identified some toxicities at higher doses but these were mitigated once the maximum tolerated dose was discovered, Ramanathan notes. This agent will be explored in combination with nab-paclitaxel and gemcitabine in one trial and with FOLFIRINOX in the second investigation.
Incyte recently announced promising phase II results for the JAK1/2 inhibitor ruxolitinib plus capecitabine as a second-line treatment for patients with pancreatic cancer, notes moderator Johanna Bendell, MD. Based on a blood test, approximately 50% to 60% of patients in the study expressed a biomarker that suggested a response to ruxolitinib, Ramanathan notes. In the early results, the 6-month PFS was nearly tripled.