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Napabucasin Combination Shows Early Signs of Activity in Pancreatic Cancer

Angelica Welch
Published: Tuesday, Jul 18, 2017

Tanios Bekaii-Saab, MD

Tanios Bekaii-Saab, MD

The first-in-class stemness inhibitor napabucasin (BBI-608) is being studied in combination with gemcitabine and nab-paclitaxel in patients with metastatic pancreatic adenocarcinoma.

at the GI Congress, lead author Tanios Bekaii-Saab, MD, professor of Medicine, Mayo Clinic, discussed the promise of napabucasin in a disease that lacks treatment options.

OncLive: Please provide an overview of your study.

Bekaii-Saab: At this year’s World Congress on Gastrointestinal Cancer, we presented the results of one of our studies that is looking at an agent called napabucasin. It is a first-in-class agent in terms of its targets—which are thought to be very important in cancer stemness. So, the whole concept of cancer stem cells and stemness—we know it is one of the major bad drivers in cancer because it makes it tough for chemotherapy to work effectively by creating these mechanisms of resistance. These are super resistant cells. The stemness factor is equally interesting because it is under pressure and a lot of the cancer cells can revert back to that stemness effect and even back to cancer stem cells, which essentially makes it very difficult to kill. The agent essentially targets pathways that are very relevant to stem cells and stemness. And preclinically, it seemed very promising when combined with various chemotherapies including taxanes and gemcitabine.

Then, we looked at the safety—which was one of the primary endpoints of the study—and it appears that napabucasin does not add to the toxicities of the chemotherapy regimen itself. There are additional GI toxicities, primarily diarrhea, but these tend to resolve within 24 hours after stopping the drug and readjusting, or can be managed with supportive care. It is a learning curve, like with all of these new first-in-class agents, you tend to learn with the first patient or two. We learned in our experience that it is actually easy to manage and most of these patients actually do extremely well on this treatment. 

What are the next steps?

The cumulative knowledge from this study essentially led to the development of the phase III study that is ongoing, CanStem 111P, which is essentially a standard-of-care arm of gemcitabine plus nab-paclitaxel plus napabucasin versus gemcitabine and nab-paclitaxel. Very straightforward—standard-of-care plus the experimental agent versus standard-of-care.
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