A multicenter, randomized phase 2 study to establish combinations of CBP501, cisplatin and nivolumab for ≥3rd-line treatment of patients with advanced pancreatic adenocarcinoma

BACKGROUND

There is no standard of care for ≥ 3rd-line treatment of metastatic pancreatic adenocarcinoma (PDAC). CBP501 is a novel calmodulin-binding peptide that has been shown to enhance the influx of platinum agents into tumor cells and tumor immunogenicity. This study aimed to (1) confirm efficacy of CBP501/cisplatin/nivolumab for metastatic PDAC observed in a previous phase 1 study, (2) identify combinations that yield 35% 3-month progression-free survival rate (3MPFS) and (3) define the contribution of CBP501 to the effects of combination therapy.

METHODS

CBP501 16 or 25 mg/m2 (CBP(16) or CBP(25)) was combined with 60 mg/m2 cisplatin (CDDP) and 240 mg nivolumab (nivo), administered at 3-week intervals. Patients were randomized 1:1:1:1 to (1) CBP(25)/CDDP/nivo, (2) CBP(16)/CDDP/nivo, (3) CBP(25)/CDDP and (4) CDDP/nivo, with randomization stratified by ECOG PS and liver metastases. A Fleming two-stage design was used, yielding a one-sided type I error rate of 2.5% and 80% power when the true 3MPFS is 35%.

RESULTS

Among 36 patients, 3MPFS was 44.4% in arms 1 and 2, 11.1% in arm 3% and 33.3% in arm 4. Two patients achieved a partial response in arm 1 (ORR 22.2%; none in other arms). Median PFS and OS were 2.4, 2.1, 1.5 and 1.5 months and 6.3, 5.3, 3.7 and 4.9 months, respectively. Overall, all treatment combinations were well tolerated. Most treatment-related adverse events were grade 1-2.

CONCLUSIONS

The combination CBP(25)/(16)/CDDP/nivo demonstrated promising signs of efficacy and a manageable safety profile for the treatment of advanced PDAC.

CLINICAL TRIAL REGISTRATION

NCT04953962.

The development of heart and heart-lung transplantation at Stanford. Honored guest's lecture

Transplantation of the heart is now accepted and perhaps even routine therapy for patients near death from heart disease. Better, more specific, less toxic molecules are under investigation for the control of rejection. The Holy Grail of tolerance is not beyond the realm of possibility. The mini-chimera concept almost certainly raises the specter of potentially successful xenografts. If not in this decade, certainly in this generation. Transplantation of the heart and both lungs constituted the first successful lung transplant of any kind. The ultimate division of indications for single lung, sequential bilateral lung, or heart-lung transplantation will be settled only by the accumulation of more clinical data. With respect to pulmonary transplantation, a few technical points have become clear. First, the double lung transplant with a tracheal anastomosis has been abandoned owing to the complications of tracheal stenosis and tracheal dehiscence. Second, there is no need to wrap the bronchial anastomosis with omentum; there is no need to "telescope" the donor bronchus. Finally, simple, continuous polypropylene suture technique should be used for any tracheal (heart-lung transplantation) or bronchial anastomosis.

Pediatric heart transplantation at Stanford: results of a 15-year experience

The long-term results of pediatric heart transplantation were evaluated in 53 patients, aged 0.25 to 18.94 years, who received transplants at Stanford University Medical Center between 1974 and 1989. Indications for transplantation were idiopathic cardiomyopathy (68%), congenital heart disease (21%), endocardial fibroelastosis (8%), and doxorubicin cardiomyopathy (3%). Immunosuppression was achieved with combinations of cyclosporine, prednisone, and azathioprine. Thirty-seven of 42 recipients leaving the hospital after transplantation were alive and in New York Heart Association class I at study's end. Cumulative survival was 79% at 1 year, 76% at 3 years, and 69% at 5 years. Fourteen recipients have survived more than 5 years (5.1 to 12.4 years). Hospital readmission for illness has been infrequent, decreasing from 6.8 days to 0.9 days per year over 5 years. Eleven patients have required no rehospitalization. Posttransplant deaths were due to infection (19%), rejection (4%), pulmonary hypertension (4%), coronary artery disease (2%), and lymphoproliferative disease (2%). Retransplantation was required for intractable rejection in 4 patients and advanced coronary artery disease in 2. Hypertension and elevated blood urea nitrogen and creatinine levels were common in individuals receiving cyclosporine. Growth was often impaired in prepubertal children receiving daily prednisone. Based on this 15-year experience, it is concluded that heart transplantation represents a reasonable alternative for selected young patients with end-stage cardiac disease.

Results of intraventricular baffle procedure for ventricular septal defect and double outlet right ventricle or d-transposition of the great arteries

Thirty patients with ventricular septal defect and d-transposition of the great arteries or double outlet right ventricle underwent placement of an intraventricular baffle to achieve physiologic correction. Eighteen of these patients also required an external conduit to establish continuity between the right ventricle and the pulmonary artery. There was an overall 22 percent early mortality rate, although the rate was 63 percent in patients who weighed less than 10 kg. There was an additional 20 percent late mortality rate, primarily related to conduction disturbances and pulmonary vascular obstructive disease, problems that have not occurred in patients operated on since 1974. Of the survivors, all are asymptomatic and as a group have achieved a significant weight gain. Many have residual hemodynamic abnormalities that required cardiac catheterization for precise assessment. Four patients have been reoperated on, with no additional mortality.

An important complication of Hancock mitral valve replacement in children

Nine children ages 2--15 years have undergone mitral valve replacement (MVR) with Hancock porcine heterograft valves for severe mitral insufficiency. The etiology of the mitral valve disease was rheumatic in two patients, and congenital in seven. Porcine valve sizes ranged from 19--31 mm. Follow-up has been from 1.6 to 6.1 years (mean, 4.3 years). All nine children have had marked postoperative improvement, no thromboembolic complications despite no long-term anticoagulations, and no episodes of endocarditis. There have been no early or late deaths. Although six of the nine patients remain asymptomatic, three others developed severe fibrocalcific obstruction of the heterograft, requiring valve re-replacement at 3.5, 3.6, and 4.8 years following the initial valve replacement. This complication has not been previously reported in children. It is a factor that must be considered when deciding on MVR for children and their postoperative management.