ASCO Perspective
“To see any survival benefit in a trial for metastatic pancreatic cancer is of interest. The investigators have evaluated a subset of pancreatic cancer, KRAS wild-yype, which is rarely investigated prospectively because this form of the cancer represents less than 10% of all pancreatic cancer patients. Additional studies in comparison with the combination of gemcitabine/nab-paclitaxel would be of interest. We should consider validating any potential advances to make a true difference in the lives of all patients with pancreatic cancer,” said Cathy Eng, MD, FACP, FASCO, ASCO Expert in gastrointestinal cancers.

CHICAGO — The addition of nimotuzumab to gemcitabine (Gemzar^®) increases overall survival in patients with K-Ras wild-type advanced pancreatic cancer, particularly for patients who did not need surgery for obstruction of a pancreatic bile duct, according to new research to be presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.

Study at a Glance

Key Findings
Median overall survival was longer for patients in the nimotuzumab-gemcitabine group (10.9 months) compared to those who received gemcitabine plus a placebo (8.5 months). The one-year survival rate was 43.6% in the nimotuzumab-gemcitabine group vs. 26.8% in the placebo-gemcitabine group and 13.9% vs. 2.7% for three-year survival, respectively. The median PFS was 4.2 months in the nimotuzumab-gemcitabine group vs. 3.6 months in the placebo-gemcitabine group.

The overall survival benefit in patients who did not need surgery to remove a biliary obstruction was 11.9 vs. 8.5 months. For those who had no surgical history, it was 15.8 vs. 6.0 months for the nimotuzumab-gemcitabine vs. placebo-gemcitabine groups, respectively. PFS for those who had no surgical history for a biliary obstruction was 5.5 vs. 3.4 months in the nimotuzumab-gemcitabine vs. placebo-gemcitabine groups, respectively.

The incidence of adverse events in the nimotuzumab-gemcitabine group was similar to the placebo-gemcitabine group. The most common adverse events for those who received nimotuzumab-gemcitabine were neutropenia (11.1%), leukopenia (8.9%) and thrombocytopenia (6.7%), all of which affect blood cells in the body.

“We believe our NOTABLE trial will be a breakthrough in the field of pancreatic cancer. The outcomes in this trial may bring new hope to patients with K-Ras wild-type pancreatic cancer,” said co-lead author Shukui Qin, MD, who is a full Professor & Chief Physician of the Cancer Center, Jinling Hospital, Nanjing University of Chinese Medicine. Dr. Qin’s co-lead author is Jin Li, MD, who is a full Professor & Director of the Oncology Department at the East Hospital of Shanghai Tongji University, China.

An estimated 62,210 people in the United States (U.S.) will be diagnosed with pancreatic cancer this year. When diagnosed at an advanced stage, current therapies provide a median overall survival benefit of approximately six to eight monthsⁱ.

Pancreatic cancer rates in China are increasing. Cases in China account for about 25.2% (124,994 new cases in 2020) of all newly diagnosed cancers and about 26.1% (121,853 deaths in 2020) of deaths from pancreatic cancer worldwideⁱⁱ. Mutations in the K-Ras gene account for 85% to 90% of all pancreatic cancers; 10% to15% of pancreatic cancers are K-Ras wild type (unmutated).

Nimotuzumab is a monoclonal antibody that targets the epidermal growth factor receptor (EGFR) on a cell’s surface and can inhibit the growth of tumor cells that overexpress EGFR. The drug, developed as a joint Chinese-Cuban venture, was approved by the Chinese National Medical Products Administration to be marketed in China in 2008 for the treatment of nasopharyngeal carcinoma. A series of clinical studies of nimotuzumab for head and neck, cervical, esophageal, and other cancers are ongoing in China. The drug has not been approved by the U.S. Food and Drug Administration.

About the Study
In the prospective double-blind phase III NOTABLE clinical trial, patients in China with locally advanced or metastatic pancreatic cancer were randomly assigned to receive either nimotuzumab followed by gemcitabine or a placebo plus gemcitabine until progression or unacceptable toxicity. The researchers conducted subgroup analyses based on whether the patients needed surgery to remove bile duct obstructions prior to receiving chemotherapy. Patients without the need for surgery to repair obstructions have better liver function, no jaundice and may therefore better tolerate chemotherapy.

The primary endpoint was OS and secondary endpoints included PFS, objective response rate, and safety.

Next Steps
The patients in the study continue to be followed up for effects on OS and long-term safety endpoints. The investigators continue to recruit patients in order to enroll a population that is as representative of the real-world population of pancreatic cancer patients as possible.

This trial was conducted in China and sponsored by Biotech Pharmaceutical Corp. Ltd.

View the full abstract

View the author disclosures

View the disclosures for ASCO’s Cancer Communications Committee: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2022-asco-ccc-disclosures.pdf

For your readers:

• Guide to Pancreatic Cancer
• Placebos in Cancer Clinical Trials
• Cancer.Net Blog Post (English)
• Cancer.Net Blog Post (Spanish)

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