UNC Lineberger Comprehensive Cancer Center has opened a two-arm clinical trial to determine the optimal combination treatment for patients with advanced unresectable or metastatic basal-like subtype pancreatic ductal adenocarcinoma (PDAC). Investigators seek to examine the safety, efficacy, tolerability, and anti-tumor effects of low-dose epidermal growth factor receptor (EGFR) inhibitors in combination with bi-weekly gemcitabine/nab-paclitaxel (GnP).
The current standard of care chemotherapy for first-line advanced PDAC is FOLFIRINOX, NALIRIFOX, or GnP, although multiple studies suggest that patients with basal-like subtype tumors do not respond to FOLFIRINOX. However, retrospective analyses have demonstrated that adding an EGFR inhibitor such as erlotinib to GnP demonstrates improved rates of response in subjects with basal-like PDAC.
In a previous study conducted at UNC Lineberger, investigators developed a tool called Purity Independent Subtyping of Tumors (PurIST), which classifies PDAC tumors as either “basal-like” or “classical.” This new study will use PurIST to subtype the tumors of patients with PDAC and assign them to one of two arms. Patients with classical tumors will be treated on standard-of-care oxaliplatin-based triplet chemotherapy, and patients with basal-like tumors will receive the erlotinib combination treatment to determine long-term outcomes.
The PANGEA trial is also based on team science conducted in the labs of Jen Jen Yeh, MD, and Gary Johnson, PhD, that was recently published in Cancer Discovery. This multidisciplinary collaboration identified two kinotypes in pancreatic cancer that differentiate basal-like and classical PDAC and determined via retrospective analysis of two clinical trials that only patients with basal-like kinotype tumors derive significant benefit from EGFR inhibitors, an important discovery that helped to establish key framework for the PANGEA trial.
—Tyler Rice, UNC Lineberger Pancreatic Cancer Center of Excellence