# Efficacy of cadonilimab in combination with nimotuzumab and AG regimen in TMB-H/KRAS wild-type advanced pancreatic cancer: a case report

## TL;DR

A new drug combination improved outcomes for a patient with advanced pancreatic cancer marked by high tumor mutations and normal KRAS status.

## Contribution

A novel four-drug regimen showed promising efficacy and low toxicity in a TMB-H/KRAS wild-type pancreatic cancer case.

## Key findings

- The patient's pancreatic tumor shrank by 37% after two cycles of treatment.
- Partial remission was maintained for over seven months with manageable side effects.
- Combining cadonilimab, nimotuzumab, paclitaxel, and gemcitabine showed potential for this cancer subtype.

## Abstract

Advanced pancreatic cancer carries a dismal prognosis. Current chemotherapy provides limited survival benefit while causing substantial toxicity. Despite numerous trials, combining gemcitabine with other cytotoxic or targeted agents has not significantly improved outcomes, highlighting the urgent need for novel therapeutic strategies.

This report describes a 56-year-old male diagnosed with stage IVB pancreatic tail adenocarcinoma, characterized by a high tumor mutational burden (TMB-H) and a KRAS wild-type status. The patient showed a significant therapeutic response and an improved quality of life after receiving a novel four-drug combination regimen. The treatment included cadonilimab (a PD-1/CTLA-4 bispecific antibody), nimotuzumab (an EGFR monoclonal antibody), albumin-bound paclitaxel, and gemcitabine. After two cycles, the primary pancreatic lesion reduced by 37%, and there was substantial shrinkage of hepatic metastases. Continued treatment maintained partial remission (PR), with progression-free survival (PFS) lasting over seven months and manageable toxicity.

This case highlights the potential of the combination of cadonilimab, nimotuzumab, albumin-bound paclitaxel, and gemcitabine as an effective, low-toxicity treatment option for patients with TMB-H/KRAS wild-type advanced pancreatic cancer.