Phase 2 study of ipilimumab, nivolumab, and tocilizumab combined with stereotactic body radiotherapy in patients with refractory pancreatic cancer (TRIPLE-R). (February 2023)

• Record Type: Journal Article
• Authors: Chen, Inna M.; Donia, Marco; Chamberlain, Christopher A.; Jensen, Agnete W.P.; Draghi, Arianna; Theile, Susann; Madsen, Kasper; Hasselby, Jane P.; Toxværd, Anders; Høgdall, Estrid; Lorentzen, Torben; Wilken, Eva E.; Geertsen, Poul; Svane, Inge M.; Johansen, Julia S.; Nielsen, Dorte
• Is Part Of: European journal of cancer. Volume 180(2023)
• Page Start: 125
• Page End: 133
• Publication Date: 2023-02
• Subjects: Pancreatic cancer -- Ipilimumab -- Nivolumab -- Tocilizumab -- Stereotactic body radiotherapy -- TRIPLE-R; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.11.035
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Interleukin-6 blockade and radiation combined with immunotherapy may modulate the tumour microenvironment to overcome immune resistance. We assessed the efficacy of ipilimumab, nivolumab, and tocilizumab combined with stereotactic body radiotherapy (SBRT) in patients with refractory pancreatic cancer (PC). Methods: Patients with PC who had progressive disease (PD) or intolerance to gemcitabine- or fluorouracil-containing regimens were enrolled in Part A of the two-part, single-centre, phase 2 study (NCT04258150). SBRT with 15 Gy was administered on day one of the first cycle. Ipilimumab was administered (1 mg/kg every 6 weeks) for a maximum of two infusions. Nivolumab (6 mg/kg) and tocilizumab (8 mg/kg) were given every four weeks until the PD or unacceptable toxicity, or for up to one year. The primary end-point was the objective response rate, with a threshold of 15%. Results: Twenty-six patients were enrolled and treated between April 17, 2020, and January 25, 2021. The median follow-up time at the time of data cutoff (February 7, 2022) was 4.9 months (interquartile range 2.1–7.7). No responses were observed. Five patients (19%; 95% confidence intervals [CI], 7–39) achieved a stable disease. The median progression-free survival was 1.6 months (95% CI 1.4–1.7), and the median overall survival was 5.3 months (95% CI 2.3–8.0). Overall, 19 (73%) experienced adverse events related to the treatment including two (8%) with grade 3 or higher events. Conclusion: The combination of ipilimumab, nivolumab, tocilizumab, and SBRT in patients with PC did not meet the prespecified criteria for expansion for full accrual. Highlights: Ipilimumab/nivolumab/tocilizumab/radiation was evaluated in pancreatic cancer. No clinically meaningful efficacy was observed. No unanticipated safety signals were registered. No changes in the tumour-infiltrating lymphocytes were induced. The serum IL-6 level prior to treatment was associated with survival.