Dr. Ramanathan on Emerging Therapeutic Targets in Patients With Pancreatic Cancer

Ramesh K. Ramanathan, MD, director, Gastrointestinal Medical Oncology Program, Mayo Clinic, discusses emerging therapeutic targets in patients with pancreatic cancer.

There has been a lot of attention on the pancreatic stroma, says Ramanathan. There has been a lot of research focusing on agents that affect the stroma in combination with chemotherapy. Pegylated hyaluronidase (PEGPH20) has been examined in clinical trials in combination with FOLFIRINOX. That study yielded negative results, says Ramanathan.

There is a pilot study with gemcitabine and nab-paclitaxel (Abraxane) which has not shown a detrimental effect on patients. Patients who have high levels of hyaluronan seem to benefit from PEGPH20 with gemcitabine and nab-paclitaxel. The combination has shown promising efficacy, says Ramanathan. This has led to a phase III study with a biomarker component.

A number of other drugs targeting the stroma are being examined. Napabucasin (BBI608) is currently in a randomized phase III study with gemcitabine and nab-paclitaxel.