- Padrón, Lacey J;
- Maurer, Deena M;
- O’Hara, Mark H;
- O’Reilly, Eileen M;
- Wolff, Robert A;
- Wainberg, Zev A;
- Ko, Andrew H;
- Fisher, George;
- Rahma, Osama;
- Lyman, Jaclyn P;
- Cabanski, Christopher R;
- Yu, Jia Xin;
- Pfeiffer, Shannon M;
- Spasic, Marko;
- Xu, Jingying;
- Gherardini, Pier Federico;
- Karakunnel, Joyson;
- Mick, Rosemarie;
- Alanio, Cécile;
- Byrne, Katelyn T;
- Hollmann, Travis J;
- Moore, Jonni S;
- Jones, Derek D;
- Tognetti, Marco;
- Chen, Richard O;
- Yang, Xiaodong;
- Salvador, Lisa;
- Wherry, E John;
- Dugan, Ute;
- O’Donnell-Tormey, Jill;
- Butterfield, Lisa H;
- Hubbard-Lucey, Vanessa M;
- Ibrahim, Ramy;
- Fairchild, Justin;
- Bucktrout, Samantha;
- LaVallee, Theresa M;
- Vonderheide, Robert H
Chemotherapy combined with immunotherapy has improved the treatment of certain solid tumors, but effective regimens remain elusive for pancreatic ductal adenocarcinoma (PDAC). We conducted a randomized phase 2 trial evaluating the efficacy of nivolumab (nivo; anti-PD-1) and/or sotigalimab (sotiga; CD40 agonistic antibody) with gemcitabine/nab-paclitaxel (chemotherapy) in patients with first-line metastatic PDAC ( NCT03214250 ). In 105 patients analyzed for efficacy, the primary endpoint of 1-year overall survival (OS) was met for nivo/chemo (57.7%, P = 0.006 compared to historical 1-year OS of 35%, n = 34) but was not met for sotiga/chemo (48.1%, P = 0.062, n = 36) or sotiga/nivo/chemo (41.3%, P = 0.223, n = 35). Secondary endpoints were progression-free survival, objective response rate, disease control rate, duration of response and safety. Treatment-related adverse event rates were similar across arms. Multi-omic circulating and tumor biomarker analyses identified distinct immune signatures associated with survival for nivo/chemo and sotiga/chemo. Survival after nivo/chemo correlated with a less suppressive tumor microenvironment and higher numbers of activated, antigen-experienced circulating T cells at baseline. Survival after sotiga/chemo correlated with greater intratumoral CD4 T cell infiltration and circulating differentiated CD4 T cells and antigen-presenting cells. A patient subset benefitting from sotiga/nivo/chemo was not identified. Collectively, these analyses suggest potential treatment-specific correlates of efficacy and may enable biomarker-selected patient populations in subsequent PDAC chemoimmunotherapy trials.