title: Phase 2 trial of single agent Ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma.
abstract: New, effective therapies are needed for pancreatic ductal adenocarcinoma. Ipilimumab can mediate an immunologic tumor regression in other histologies. This phase II trial evaluated the efficacy of Ipilimumab for advanced pancreatic cancer. Subjects were adults with locally advanced or metastatic pancreas adenocarcinoma with measurable disease, good performance status, and minimal comorbidities. Ipilimumab was administered intravenously (3.0 mg/kg every 3 wk; 4 doses/course) for a maximum of 2 courses. Response rate by response evaluation criteria in solid tumors criteria and toxicity were measured. Twenty-seven subjects were enrolled (metastatic disease: 20 and locally advanced: 7) with median age of 55 years (27 to 68 y) and good performance status (26 with Eastern Cooperative Oncology Group performance status =0 to 1). Three subjects experienced ≥ grade 3 immune-mediated adverse events (colitis:1, encephalitis:1, hypohysitis:1). There were no responders by response evaluation criteria in solid tumors criteria but a subject experienced a delayed response after initial progressive disease. In this subject, new metastases after 2 doses of Ipilimumab established progressive disease. But continued administration of the agent per protocol resulted in significant delayed regression of the primary lesion and 20 hepatic metastases. This was reflected in tumor markers normalization, and clinically significant improvement of performance status. Single agent Ipilimumab at 3.0 mg/kg/dose is ineffective for the treatment of advanced pancreas cancer. However, a significant delayed response in one subject of this trial suggests that immunotherapeutic approaches to pancreas cancer deserve further exploration.
authors.affiliation: Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. rroyal@mdanderson.org
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Catherine
authors.initials: C
authors.lastname: Levy
authors.forename: Keli
authors.initials: K
authors.lastname: Turner
authors.forename: Aarti
authors.initials: A
authors.lastname: Mathur
authors.forename: Marybeth
authors.initials: M
authors.lastname: Hughes
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Topalian
authors.forename: James C
authors.initials: JC
authors.lastname: Yang
authors.forename: Israel
authors.initials: I
authors.lastname: Lowy
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rosenberg
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D015703:Antigens, CD / Q000276:immunology*; D060908:CTLA-4 Antigen; D003092:Colitis / Q000209:etiology / Q000276:immunology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007275:Injections, Intravenous; D000074324:Ipilimumab; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure
chemical_list: D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D000074324:Ipilimumab