scholarly journals SAT-186 Metastatic Paraganglioma Secondary to SDHB Gene Mutation: A Case Report and Review of New Therapies

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maryam Tetlay ◽  
Farhad Hasan
Keyword(s):  
Clinical Trial ◽  
Gene Mutation ◽  
Metastatic Disease ◽  
Wedge Resection ◽  
Uncontrolled Hypertension ◽  
Cancer Center ◽  
Retroperitoneal Mass ◽  
Lower Quadrant ◽  
Familial Pheochromocytoma ◽  
Sdhb Gene

Abstract Background: Paragangliomas (PGL) are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, majority of which are benign. 0-36% of PGL patients can develop metastatic disease, depending on the genetic mutation. We present a case of a patient with metastatic PGL due to an SDHB gene mutation. We then summarize published and ongoing trials of therapies for metastatic pheochromocytoma/PGL. Clinical Case: A 54 years old male presented to the Emergency Department with severe left lower quadrant pain. He additionally reported recent episodes of headaches and uncontrolled hypertension, as well as an approximate weight loss of 50 pounds in the preceding two years. A CT abdomen and pelvis demonstrated an 8 cm left peri-aortic retroperitoneal mass, along with a 2 cm solitary hepatic lesion concerning for metastatic disease. Normetanephrine levels were elevated at 1210 pg/mL (normal 0-145 pg/mL). Endoscope-guided biopsy of the retroperitoneal mass demonstrated findings consistent with a PGL. The patient was referred to a genetic counsellor where he underwent PGLNext testing. He tested positive for a c.418G>T mutation in the SDHB gene, consistent with a diagnosis of hereditary paraganglioma - pheochromocytoma (PGL-Pheo) syndrome. Patient was planned for surgical debulking of his PGL, and was treated pre-operatively with Phenoxybenzamine, followed by B-blockers. He underwent resection of the retroperitoneal mass and wedge resection of the hepatic mass. Surgical pathology revealed a 10.5 cm extra adrenal PGL and a 2 cm metastatic PGL involving the liver with negative margins of resection. Patient did well in the post-operative period, and was discharged with plans to repeat plasma metanephrines in 6-8 weeks. The patient was referred to the National Cancer Institute (NCI) for enrollment in a clinical trial using Lu-177-DOTATATE. Conclusion: Though rare, pheochromocytomas (pheo) and PGL can be lethal if not diagnosed and managed appropriately. As of 2019, at least 19 genes have been identified that predispose to familial pheochromocytoma/PGL. Importantly, PGL that are associated with SDHB, the mutation our patient had, are more likely to appear in the abdomen (rather than the head and neck), are usually secretory (most commonly norepinephrine) and are more likely to become metastatic (21-79%). Patients with metastatic pheo/PGL require complex care in specialized centers by a multidisciplinary team of specialists. Patients with advanced or non-resectable metastatic pheo/PGL should preferably be offered a referral to NCI or an NCI designated cancer center for enrollment in a clinical trial of targeted therapies.

scholarly journals Reversible Catecholamine Induced Cardiomyopathy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A1005-A1005
Author(s):  
Kathrin Sandra Tofil ◽  
Malek Mushref
Keyword(s):  
Neuroendocrine Tumor ◽  
Metastatic Disease ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Endocrine Tumors ◽  
Retroperitoneal Mass ◽  
Distal Pulse ◽  
Hepatic Lesions ◽  
Poor Outcomes ◽  
The Right

Abstract Background: Pheochromocytomas and paragangliomas (PPGL) are rare neuro-endocrine tumors associated with a myriad of poor outcomes as a result of long-term exposure to catecholamines. Although paragangliomas are less commonly associated with increased catecholamine production than adrenal pheochromocytomas, there have been a few reports of catecholamine-induced cardiomyopathy in patients diagnosed with PPGL. We report a case of a PPGL associated with hypercoagulability and cardiomyopathy. Clinical Case: 42-year-old man with uncontrolled hypertension presented to the emergency department with abdominal pain. On CT imaging, he was found to have hepatic lesions, aortocaval lymph node concerning for metastatic disease, left renal infarct, and a left ventricular thrombus. Soon after his admission, he developed acute ataxia, gaze palsies and left hemiparalysis. CTA of the head showed a basilar artery thrombus [FJ1] which was treated with emergent thrombectomy. In addition patient had absent distal pulse of the right foot[FJ2], and found to have thrombus of the popliteal artery, which was treated with thrombectomy. Further workup with abdominal MRI showed retroperitoneal mass[FJ3] and multiple hepatic lesions concerning for metastatic extra-adrenal neuroendocrine tumor. Plasma normetanephrine was 4.5 nmol/L (ULN 0.89), plasma metanephrine 0.3 nmol/L (ULN 0.49) Chromogranin A was 387 ng/ml (ULN 160). Ga-68 DOTATE scan was consistent with an extra adrenal paraganglioma with less prominent radiotracer activity in hepatic lesion concerning for dedifferentiated metastatic disease. In addition, echocardiogram showed reduced LV ejection fraction of 24% with global hypokinesis, and confirmed the LV thrombus. Cardiac MRI showed infiltrative nonischemic cardiomyopathy and mild dilation of left ventricle, as well as patchy delayed enhancement in the basal and inferoseptal walls suggestive of myocarditis. Treatment included rivaroxaban[FJ4], lisinopril, doxazosin, furosemide, and carvedilol. Several months after discharge, his EF improved to 48%. Hepatic lesions concerning for dediffertiated tumor vs unrelated malignancy was biopsied[FJ5] and consistent with neuroendocrine tumor. Future plan for his PPGL include revaluation for resection of retroperitoneal mass or DOTA Lutathera therapy. Conclusions: This case highlights a young man who was incidentally found to have metastatic paraganglioma with catecholamine-induced cardiomyopathy. The patient was asymptomatic until he developed significant heart failure. Cardiomyopathy in this setting is thought to be secondary to uncontrolled hypertension, as well as sympathetic overdrive from overstimulation of norepinephrine. We present the case to highlight the management challenges in a patient with PPGL with significant cardiovascular compromise and limited therapeutic options.

Characteristics of the screen-failure (SF) patient population in an early castrate-resistant prostate cancer vaccine clinical trial: Lessons for future trial design.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 241-241
Author(s):  
Daniel A. Vaena ◽  
Pamela Zehr ◽  
Karen Griffith ◽  
Erica Brown ◽  
James A Brown ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Metastatic Disease ◽  
Doubling Time ◽  
Treated Group ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patient Death ◽  
Eligibility Criteria ◽  
Psa Doubling Time ◽  
Study Therapy

241 Background: AdPSA is an investigational replication-deficient adenovirus-based PSA vaccine. A prior phase I trial in patients (pts) with metastatic CRPC showed safety and ability to generate immune responses. We are conducting a phase II trial in early CRPC in our comprehensive cancer center + VA. This study contains an analysis of the SF (post-informed consent) population. Methods: Patients with CRPC defined as rising PSA despite androgen deprivation therapy are eligible for this trial. Main eligibility criteria requires a bone scan, chest X-ray and abdomen pelvis CT without evidence of metastatic disease (any PSA or PSA doubling time allowed). Pts with metastatic disease are also eligible if they have a PSA doubling time greater than 6 months and a PSA less than 10 and are asymptomatic. Prior antiandrogens or ketoconazole are allowed, provided the PSA is rising. Prior chemotherapy or sipuleucel-T is not allowed. Results: 38 pts have been consented for the clinical trial, of which 21 pts have proceeded with study therapy. 17 pts were SF for the following reasons: 13 had positive CT and/or bone scans with exclusionary PSA or PSADT values, 1 had declining PSA prior to starting therapy, and for 3 pts initiation of study therapy was contraindicated (second cancer discovered on CT, aggressive pace of progression, and unrelated patient death). Median PSA was 10.2 for SF vs 1.9 ng/mL for treated pts. 6 SF patients had PSA < 5 ng/mL. 26 pts had prior bicalutamide (12 SF, 14 treated group). Prior ketoconazole was rare in both groups. The vast majority of pts who were treated did not have metastatic disease. Conclusions: In a large academic cancer center, it is challenging but possible to find patients with early non-metastatic CRPC. Higher PSA may predict SF, but several patients with PSA < 5 ng/mL also had metastases on screen. Prior antiandrogen is not a predictor for SF. Since this abstract only relates to patients who consented for the trial, the denominator of cancer center patients with early CRPC (but not eligible) is even larger. This information will help accrual estimates in cancer centers and feasibility assessment of early CRPC studies.

scholarly journals IMG-07. GADOLINIUM IS NOT NECESSARY FOR SURVEILLANCE MR IMAGING IN CHILDREN WITH CHIASMATIC-HYPOTHALAMIC LOW GRADE GLIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii356-iii356
Author(s):  
Fatema Malbari ◽  
Murali Chintagumpala ◽  
Jack Su ◽  
Mehmet Okcu ◽  
Frank Lin ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Three Dimensional ◽  
Low Grade Glioma ◽  
Cancer Center ◽  
Low Grade ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Best Response ◽  
Dimensional Measurements ◽  
Initiation Of Therapy

Abstract BACKGROUND Patients with chiasmatic-hypothalamic low grade glioma (CHLGG) have frequent MRIs with gadolinium based contrast agents (GBCA) for disease monitoring. Cumulative gadolinium deposition in children is a potential concern. The purpose of this research is to establish whether MRI with GBCA is necessary for determining tumor progression in children with CHLGG. METHODS Children with progressive CHLGG were identified from Texas Children’s Cancer Center between 2005–2019. Pre- and post-contrast MRI sequences were separately reviewed by one neuroradiologist who was blinded to the clinical course. Three dimensional measurements and tumor characteristics were collected. Radiographic progression was defined as a 25% increase in size (product of two largest dimensions) compared to baseline or best response after initiation of therapy. RESULTS A total of 28 patients with progressive CHLGG including 683 MRIs with GBCA (mean 24 MRIs/patient; range: 10–43 MRIs) were reviewed. No patients had a diagnosis of NF1. Progression was observed 92 times, 91 (98.9%) on noncontrast and 90 (97.8%) on contrast imaging. Sixty-seven radiographic and/or clinical progressions necessitating management changes were identified in all (100%) noncontrast sequences and 66 (98.5%) contrast sequences. Tumor growth &gt;2 mm in any dimension was identified in 184/187(98.4%) on noncontrast and 181/187(96.8%) with contrast imaging. Non primary metastatic disease was seen in seven patients (25%), which were better visualized on contrast imaging in 4 (57%). CONCLUSION MRI without GBCA effectively identifies patients with progressive disease. One should consider eliminating contrast in imaging of children with CHLGG with GBCA reserved for monitoring those with metastatic disease.

scholarly journals 665 Transcriptional landscape of tumor-reactive TIL in lung cancer and melanoma

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A693-A693
Author(s):  
Jiajia Zhang ◽  
Justina Caushi ◽  
Boyang Zhang ◽  
Zhicheng Ji ◽  
Taibo Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
T Cells ◽  
Informed Consent ◽  
T Cell ◽  
Cancer Center ◽  
Lung Cancers ◽  
Functional Assays ◽  
Link Type ◽  
Institutional Review

BackgroundMelanoma and lung cancers have two of the highest response rates to immune checkpoint inhibitors (ICIs).1 However, patients may respond unpredictably, partly due to heterogeneity in the quantity and quality of tumor-specific T cells. In this study, we performed an integrated transcriptomic analysis of anti-tumor CD8+ TIL from non-small cell lung cancer (NSCLC) and melanoma. Our goal was to study the global transcriptomic landscape of tumor-specific T cells and to compare their functional programming in lung cancer vs. melanoma.MethodsTIL from 19 patients (15 NSCLC and 3 melanoma) were sequenced using combined single-cell (sc) RNA-seq/TCR-seq. All NSCLC patients received neoadjuvant anti-PD-1 (nivolumab, NCT02259621) whereas melanoma patients received a personal neoantigen vaccine (NCT01970358). Neoantigen-, tumor-associated antigen-, and viral-specific CD8+ T cell clonotypes were identified using functional assays and were validated by TCR cloning as previously described.2 3 Transcriptional profiles of antigen-specific T cells were identified using the TCRβ CDR3 as a barcode to link with the antigen specificity output from the functional assays. The prevalence, phenotype, and differentiation trajectory of tumor-specific T cells were compared between the two cancer types.ResultsA total of 175,826 CD8+ TIL were analyzed, of which 30,174 single cells were from the melanoma cohort and 145,652 were from the NSCLC cohort. Tumor-specific T cells were detected at variable frequencies among CD8+ TIL (median=1.2%, range 0.01%–35.8%) across nine patients, with melanoma having more clonal tumor-specific T cells as compared to NSCLC. CD8+ TIL from melanoma were more enriched in an activated tissue resident T cell (TRM) cluster characterized by upregulated expression of CXCL13, CRTAM, 4-1BB, XCL1/2, and FABP5, whereas those from NSCLC have a greater representation of a cytotoxic TRM cluster with an exhaustion signature (coexpression of GZMB, GZMH, PDCD1, and CTLA4). Distinct from EBV-specific T cells and flu-specific T cells, tumor-specific T cells primarily resided in TRM clusters in both cancers. More MANA-specific TIL from melanoma presented with an effector phenotype and were more proliferative as compared to those from NSCLC. To reveal the differentiation trajectory and regulatory programs of tumor-specific T cells upon tumor recognition and association with response to ICIs, pseudotime/velocity analysis of tumor-specific TIL is underway.ConclusionsThis is the first analysis to inform on the global transcriptomic landscape of tumor-specific CD8+ TIL in lung cancer and melanoma at single cell resolution. This provides a useful framework to study the underlying mechanisms of T cell exhaustion and dysfunction in human cancer.Trial RegistrationNCT02259621,NCT01970358ReferencesYarchoan M, Hopkins A, Jaffee EM. Tumor mutational burden and response rate to PD-1 inhibition. The New England Journal of Medicine 2017;377(25):2500.Caushi JX, et al. Transcriptional programs of neoantigen-specific TIL in anti-PD-1-treated lung cancers. Nature 2021;1–7.Oliveira G, et al. Phenotype, specificity and avidity of antitumour CD8+ T cells in melanoma. Nature 2021;1–7.Ethics ApprovalThe melanoma clinical trial was approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (IRB) (NCT01970358). The NSCLC clinical trial was approved by the Institutional Review Boards (IRB) at Johns Hopkins University (JHU) and Memorial Sloan Kettering Cancer Center (NCT02259621). All participants gave informed consent before taking part.ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

scholarly journals Key Barriers to Clinical Trial Enrolment: A Survey of Clinical Trial Staff at an NCI Designated Cancer Center

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5864-5864
Author(s):  
Amany R. Keruakous ◽  
Adam S. Asch
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Cultural Bias ◽  
Cancer Center ◽  
Exclusion Criteria ◽  
Strict Inclusion ◽  
Trial Protocols ◽  
Trial Staff ◽  
Disease Site ◽  
Patient Enrolment

Background: Clinical trials, key elements of the processes that account for many of the recent advances in cancer care, are becoming more complex and challenging to conduct. The Stephenson Cancer Center (SCC) has been the lead accruer to NCI-LAP trials over the past three years, and in addition, fields investigator initiated and industry sponsored trials. To identify opportunities for continued improvement in clinical trial enrolment, we sought to identify the obstacles encountered by our clinical trial staff in these activities. Method: We conducted a survey of our research staff including all research nurses and disease site coordinators who participate in recruitment, screening, consenting, data collection and compliance. The survey, sent by email to the clinical trial list-serve at SCC (90 staff member), invited respondents to enumerate obstacles to patient participation in clinical trials. We then performed a follow up meeting with our research coordinators to clarify responses. A total of 26 responses from 90 respondents were received and tabulated by disease site. Results: The most commonly reported obstacles to enrolment were, in descending order: communication/language barriers, cultural bias, time/procedure commitment, and complexity of the trial protocol, financial logistics, comorbidities, and stringent trial criteria. Respondents identified 83 obstacles as frequently encountered obstacles to enrolment. The 83 reported obstacles were classified into 9 categories and organized by disease site as presented in tabular format (below). The most commonly identified obstacles to patient enrolment were communication and language barriers. In patients for whom Spanish is the primary language this was a universal obstacle, as there is a lack of consistent Spanish consents across the clinical trial portfolio. Cultural bias, as an obstacle was manifested as a general mistrust by prospective trial participants of experimental therapies and clinical trials. After communication and cultural bias as barriers, travel requirements and the associated expenses playing a role in patients from rural areas were identified as the most commonly encountered barrier. The complexity of trial protocols and the associated large number of clinic visits, frequent laboratory and imaging tests were also identified as common obstacles. Clinical trial complexity with strict inclusion and exclusion criteria and trial-specified biopsies were frequently cited. Implications: In this descriptive study, common barriers to patient enrolment in clinical trials were identified by clinical trial staff. Assessing barriers encountered by clinical trial staff is infrequently used as a metric for improving clinical trial enrolment, but provides important perspective. In our study, some obstacles are inherent in our patient populations, others appear to be actionable. Development of Spanish language consents and specific programs to overcome negative bias regarding clinical trials are potential areas for improvement. The complexity of clinical trial protocols and the increasingly strict inclusion/exclusion criteria, are issues that will require consideration and action at the level of the cooperative groups and industry. Disclosures No relevant conflicts of interest to declare.

Evaluating the Financial Impact of Clinical Trials in Oncology: Results From a Pilot Study From the Association of American Cancer Institutes/Northwestern University Clinical Trials Costs and Charges Project

2000 ◽  
Vol 18 (15) ◽  
pp. 2805-2810 ◽  
Author(s):  
Charles L. Bennett ◽  
Tammy J. Stinson ◽  
Victor Vogel ◽  
Lyn Robertson ◽  
Donald Leedy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Pilot Study ◽  
Medical Care ◽  
Phase Ii ◽  
Third Party ◽  
Disease Stage ◽  
Cancer Center ◽  
Policy Debate ◽  
Economic Analyses

PURPOSE: Medical care for clinical trials is often not reimbursed by insurers, primarily because of concern that medical care as part of clinical trials is expensive and not part of standard medical practice. In June 2000, President Clinton ordered Medicare to reimburse for medical care expenses incurred as part of cancer clinical trials, although many private insurers are concerned about the expense of this effort. To inform this policy debate, the costs and charges of care for patients on clinical trials are being evaluated. In this Association of American Cancer Institutes (AACI) Clinical Trials Costs and Charges pilot study, we describe the results and operational considerations of one of the first completed multisite economic analyses of clinical trials. METHODS: Our pilot effort included assessment of total direct medical charges for 6 months of care for 35 case patients who received care on phase II clinical trials and for 35 matched controls (based on age, sex, disease, stage, and treatment period) at five AACI member cancer centers. Charge data were obtained for hospital and ancillary services from automated claims files at individual study institutions. The analyses were based on the perspective of a third-party payer. RESULTS: The mean age of the phase II clinical trial patients was 58.3 years versus 57.3 years for control patients. The study population included persons with cancer of the breast (n = 24), lung (n = 18), colon (n = 16), prostate (n = 4), and lymphoma (n = 8). The ratio of male-to-female patients was 3:4, with greater than 75% of patients having stage III to IV disease. Total mean charges for treatment from the time of study enrollment through 6 months were similar: $57,542 for clinical trial patients and $63,721 for control patients (1998 US$; P = .4) CONCLUSION: Multisite economic analyses of oncology clinical trials are in progress. Strategies that are not likely to overburden data managers and clinicians are possible to devise. However, these studies require careful planning and coordination among cancer center directors, finance department personnel, economists, and health services researchers.

Abstract T MP100: Improving Encounter Frequency, Physician Prescribing, or Patient Adherence - What Works Best for Controlling Blood Pressure? Results From a Validated Micro-Simulation Model

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Valy Fontil ◽  
Kirsten Bibbins-Domingo ◽  
Dhruv Kazi ◽  
Pamela Coxson ◽  
Steve Sidney ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Patient Adherence ◽  
The United States ◽  
Control Model ◽  
Uncontrolled Hypertension ◽  
Base Case ◽  
Treatment Intensification ◽  
Case Scenario ◽  
Base Case Scenario

Background: Only half of hypertensive adults achieve blood pressure (BP) control in the United States. Methods: We developed the BP Control Model to simulate physician- and patient-level processes relevant in achieving BP control. We validated the model by simulating the intervention arm of a recent multicenter clinical trial and used the validated model to examine the effects of isolated improvements in three modifiable processes on BP control. Data from national surveys, cohort studies, and trials were used to parameterize the model. We simulated 5,000 hypothetical adult patients with uncontrolled hypertension (systolic BP≥ 140) using probability sampling of participants from the 2009-2010 National Health and Nutrition Examination Survey. We modeled 50% improvements and ideal scenarios for each process parameter. Outcome: We reported outcomes in terms of BP control (% with SBP < 140 mmHg), and average change in BP at 52 weeks. Results: In our validation analysis, the model-predicted BP control was similar to what was achieved in the VIPER-BP clinical trial (63.5% vs. 63.8%). In our base case scenario, 24% of the NHANES-derived cohort achieved BP control at 52 weeks. In scenarios with 50% improvements, the model predicted small increases in BP control, but substantially larger and more variable effects when processes were idealized (Table). Control was reached in 77% with ideal treatment intensification, 44% with ideal encounter frequency, only 32% with ideal adherence, and 97% when all three processes were idealized. Conclusion: While improving patient adherence to medications would improve BP control, healthcare systems can achieve similar or greater success by focusing on increasing the frequency of clinical encounters and improving physicians’ prescribing behavior. The BP Control Model can be used to predict how much improvement to expect from such interventions.

Investigate the efficacy of immunotherapy for treatment of pancreatic adenocarcinoma (PDAC) with mismatch repair deficiency (dMMR).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 415-415
Author(s):  
Arish Noor ◽  
Luis E. Aguirre ◽  
Kirsten Blue ◽  
Trenton Avriett ◽  
Estrella M. Carballido ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Checkpoint Inhibitors ◽  
Objective Response ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Complete Response ◽  
Median Number ◽  
Cancer Center ◽  
Duration Of Response

415 Background: Immune checkpoint inhibitors (ICI) have been approved in solid tumors with dMMR. However, only limited data are available for PDAC with dMMR given the rarity of dMMR in PDAC. We evaluated efficacy of ICIs in PDAC with dMMR. Methods: Retrospective clinical and pathologic data were collected for patients (pts) with pancreatic adenocarcinoma from May 2017 to June 2020 at Moffitt cancer center. Results: We identified 10 pts with dMMR PDAC. The median age was 64.5 years (range: 42-86) and 4 pts were male. 4 pts had resectable disease, 3 had locally advanced and 3 had metastatic disease at initial diagnosis. MSH6 deficiency (def) was found in 2 cases, PMS2 def in 2, MLH/PMS2 def in 5, and MSH2/MSH6 in 1. 7 pts were treated with ICIs. 3 pts had locally advanced and 4 had metastatic disease when they started ICIs. 5 received Pembrolizumab (pem), 1 received ipilimumab/ nivolumab (ipi/nivo), and 1 received pem then ipi/nivo after progressive disease (PD) on pem. The median number of prior lines of chemotherapy was 1 (range 0-2). 6 pts were evaluable, and 1 had rapid disease progression after 1 dose of pem. Among 6 evaluable pts, 3 had an objective response (1: complete response and 2: partial response), and 2 had stable disease (SD). Median progression-free survival was 8.2 mo, and median overall survival was not reached with median follow-up (FU) of 6.8 mo. The median duration of response was not reached with a median FU of 22.6 mo. The pt with CR remained disease-free for up to 22 months. The pt whose treatment was switched to ipi/nivo after PD on pem achieved SD > 4mo on ipi/nivo. While on immunotherapy, one patient with ipi/nivo developed immunotherapy associated rash requiring systemic steroids, and another on pem developed hypothyroidism requiring levothyroxine. Conclusions: This series suggest ICIs can provide durable clinical efficacy in pts with dMMR PDAC.

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