Abstract PR-002: A phase II pilot trial of nivolumab (N) + albumin bound paclitaxel (AP) + paricalcitol (P) + cisplatin (C) + gemcitabine (G) (NAPPCG) in patients with previously untreated metastatic pancreatic ductal adenocarcinoma (PDAC)
Authors: Erkut Borazanci, Gayle S. Jameson, Sunil Sharma, Frank Tsai, Ronald L. Korn, Lana Caldwell, Karen Ansaldo, David T. Ting, Denise Roe, Anna Bermudez, Daniel D. Von Hoff
Journal: Cancer Research (2021)

Abstract Background: Effective therapy for the treatment of PDAC remains one of the greatest unmet oncology clinical needs. The addition of C to G and AP has shown 71% ORR in a previously reported study [JAMA Oncol. 2019 Oct 3;6(1):125-32]. In preclinical work, vitamin D (Vit D) analog therapy decreases myeloid derived suppressor cells and regulatory T cells, turning PDAC into a more immune favorable microenvironment. This trial combines AP/C/G with Vit D analog P and the anti-PD-1 antibody N as a combination therapy for patients with previously untreated metastatic PDAC. This trial evaluates the efficacy and safety of NAPPCG in that patient population (NCT02754726). Methods: Eligibility criteria include Stage IV PDAC, no prior chemotherapy for systemic disease, KPS ≥ 70, and RECIST 1.1 measurable disease. Doses are AP 125 mg/m2, G 1000 mg/m2, each infused over 30 minutes with C 25 mg/m2 infused over 60 minutes on days 1, 8, 22, and 29 of a 42-day cycle. N is given at a fixed dose of 240 mg as a 60 minute infusion on days 1, 15, and 29. P is given at a fixed dose of 25 µg IV twice weekly. Primary objective was to determine the efficacy of the combination for patients with previously untreated metastatic PDAC through determining CR, ORR, PFS, and OS. The secondary objective was to evaluate safety in patients with previously untreated metastatic PDAC. Exploratory endpoints include evaluating tissue molecular profile as it relates to treatment outcomes. Results: Trial was conducted May 2016 with enrollment completed August 2020. 35 patients have been enrolled in the study and 32 are evaluable (baseline and ≥1 follow up CT scan). Most common drug-related grade (Gr) 3-4 adverse events (AE’s), are thrombocytopenia 76% (gr 3 = 34%, gr 4 = 28%) with no serious bleeding events, anemia 37% (gr 3 = 37%, gr 4 = 0%), and CIPN 11% (gr 3 = 11%, gr 4 = 0%). Immune Related Adverse Events &amp;gt;5% were colitis (gr 3=8.6%, gr 4= 0%) and dermatitis (gr 3=8.6%, gr 4= 0%). By RECIST 1.1 criteria, the best response is 1 CR, 26 PR, 4 SD, 1 PD, yielding an 84% ORR (95% CI = (67%, 95%). Median PFS is 6 months (95% CI = (5, 8)). Median OS is 18 months (95% CI = (13, 22)). Conclusions: Although a small study, the high response rate is encouraging. Evaluation of exploratory endpoints is ongoing. Pursuing this regimen in localized PDAC is warranted due to its high ORR. Supported by grants from the Seena Magowitz Foundation, Mattress Firm, Bristol Myers Squibb, and SU2C. Citation Format: Erkut Borazanci, Gayle S. Jameson, Sunil Sharma, Frank Tsai, Ronald L. Korn, Lana Caldwell, Karen Ansaldo, David T. Ting, Denise Roe, Anna Bermudez, Daniel D. Von Hoff. A phase II pilot trial of nivolumab (N) + albumin bound paclitaxel (AP) + paricalcitol (P) + cisplatin (C) + gemcitabine (G) (NAPPCG) in patients with previously untreated metastatic pancreatic ductal adenocarcinoma (PDAC) [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PR-002.