Carlos Becerra, MD
Although response rates were low, patients with metastatic pancreatic cancer experienced a significant decrease in tumor burden after being treated with chimeric antigen receptor (CAR) T cells, according to Carlos Becerra, MD.
on Gastrointestinnal Cancers, Becerra, the interim chief of Oncology for Baylor Scott & White Health – North Texas, and medical director of the Swim Across America Innovative Clinical Trials Center at the Charles A. Sammons Cancer Center at Baylor University Medical Center at Dallas, discussed the current management and emerging therapies for patients with pancreatic cancer.
OncLive: Can you provide an overview of your presentation on the management of pancreas cancer?
: Pancreas cancer is one of the leading causes of death related to cancer. We do not have good treatments. We have made some progress in pancreas cancer, particularly with metastatic disease, since many patients present to an oncologist already with metastatic disease.
The new era of targeted therapy and immunotherapy is going to provide the additional benefits that we need for our patients with metastatic pancreas cancer.
Is there a role for checkpoint inhibitors in this field?
The immune checkpoint inhibitors pembrolizumab (Keytruda) and nivolumab (Opdivo) are being studied in pancreas adenocarcinoma. We think that there is a subgroup of patients who might benefit the most. These are the patients whose tumors are microsatellite instability-high (MSI-H). We are currently studying those patients as they become our target population.
[Pembrolizumab] has been approved across the board for all MSI-H tumors. [There is a subgroup of patients with] MSI-H tumors who have metastatic pancreas cancer.
Are there any ongoing trials that are showing promise?
There are several trials that we are excited about. As we break down the molecular makeup in mutations that occur in pancreas cancer, there is a subgroup of patients who have mutations that we think might be targetable.
In addition to that, we are heavily studying immunotherapy in these patients. We are looking to discover if there will be immune checkpoint inhibitors in combination or CAR T cells that have been modified to recognize a specific target in the tumor to attack.
What data have been shown with CAR T cells?
There are very little data available. There is a study conducted from the investigators at the University of Pennsylvania investigating CAR T cells directed against mesothelin. It was presented by Dr Gregory L. Beatty at the 2017 ASCO Annual Meeting. It showed some interesting results. Although the response rate was low, there were responses in patients with metastatic disease whose tumor burden decreased significantly after being treated with CAR T cells.
We are currently conducting a study at Baylor Scott & White Research Institute with CAR T cells directed against a different target. This study has a spin to it which is using an activating agent called rimiducid for patients with metastatic pancreas cancer who have progressed on first-line chemotherapy.
Where do you envision the treatment landscape heading in the next 5 years?
I see that chemotherapy is here to stay. We already have several backbones of chemotherapy that we can use. In addition to that, targeted therapies are making their way into a subpopulation of patients whose tumors have certain mutations.
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