Niraparib Maintenance Combinations in Advanced Pancreatic Cancer: Phase 1b/2 Results

On July 7, 2022, Kim A. Reiss and colleagues from the Abramson Cancer Center published the results of a Phase 1b/2 clinical trial in The Lancet Oncology. The study evaluated two different maintenance strategies using the PARP inhibitor Niraparib in patients with advanced pancreatic cancer whose disease had not progressed after at least 16 weeks of platinum-based chemotherapy.

Study Design

The trial randomized 91 patients in a 1:1 ratio to receive:

1. Niraparib + Nivolumab (Opdivo): Niraparib (200 mg daily) + Nivolumab (480 mg every 4 weeks).
2. Niraparib + Ipilimumab (Yervoy): Niraparib (200 mg daily) + Ipilimumab (3 mg/kg every 3 weeks).

The primary endpoint was the 6-month progression-free survival (PFS) rate.

Key Efficacy Results (Median Follow-up 23 Months)

• 6-Month PFS Rate:
  • Niraparib + Ipilimumab Group: 59.6%
  • Niraparib + Nivolumab Group: 20.6%
• The combination of Niraparib and Ipilimumab showed a significantly higher likelihood of maintaining disease control at 6 months compared to the Nivolumab combination.

Safety Profile

Grade 3 or higher adverse events occurred in 51% of patients in the Niraparib + Ipilimumab group and 22% in the Niraparib + Nivolumab group.

• Nivo Combination Side Effects: Hypertension (8%), anemia (4%), and thrombocytopenia (4%).
• Ipi Combination Side Effects: Fatigue (14%), anemia (11%), and hypertension (9%).

Conclusion

The researchers concluded that for patients with advanced pancreatic cancer responding to platinum-based chemotherapy, maintenance therapy with Niraparib plus Ipilimumab significantly improved the 6-month PFS rate. In contrast, the combination with Nivolumab was less effective in this setting. These results suggest that the choice of immunotherapy partner for PARP inhibitors is critical in pancreatic cancer maintenance.

Source: The Lancet Oncology - Niraparib Maintenance Combinations

#PancreaticCancer #Niraparib #Nivolumab #Ipilimumab #PARPInhibitor #MaintenanceTherapy #CancerResearch

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