Pancreatic cancer is an extremely high-mortality malignancy. The chemotherapy regimen of gemcitabine combined with nab-paclitaxel (GEM-NABP) serves as one of the first-line standard therapies for metastatic pancreatic cancer. Given that traditional dual HER2 blockade (pertuzumab + trastuzumab) has demonstrated preliminary efficacy in HER2-expressing solid tumors, the novel clinical strategy of dual HER2 blockade (HLX22 + trastuzumab) combined with GEM-NAP offers the potential to improve outcomes for patients with HER2-positive pancreatic cancer.
Inclusion Criteria:
* Voluntary Participation Willingly participate in the clinical study; fully comprehend the study details and sign the Informed Consent Form (ICF); commit to and demonstrate capacity to complete all trial procedures.
* Age and Gender Any gender; age ≥18 and ≤75 years at the time of ICF signing.
* Diagnosis Histologically or cytologically confirmed metastatic pancreatic ductal adenocarcinoma (PDAC).
* Prior Therapy \*No prior systemic antitumor therapy for metastatic PDAC.
\*Exception: Patients who received one cycle of chemotherapy (nab-paclitaxel + gemcitabine) as initial treatment for newly diagnosed PDAC may enroll.
\*Prior neoadjuvant/adjuvant therapy is permitted if completed \>6 months before enrollment, and treatment-related adverse events (AEs) have recovered to NCI-CTCAE ≤ Grade 1 (alopecia excluded).
* Measurable Disease At least one measurable lesion per RECIST v1.1, assessed by the investigator. Target lesions must not be exclusively bone metastases.
* HER2 Status \*HER2-positive defined by ASCO/CAP gastric cancer HER2 testing guidelines: IHC 3+ (primary or metastatic lesion), or IHC 2+ with ISH/FISH-positive confirmation.
\*Note: ≤15 patients with IHC 2+/FISH-positive status may enroll.
* Performance Status ECOG performance status 0 or 1 within 7 days prior to first dose.
* Life Expectancy Expected survival ≥3 months.
* Hepatitis B \*HBsAg-negative and HBcAb-negative. \*If HBsAg-positive or HBcAb-positive, HBV-DNA must be \<2500 copies/mL or 500 IU/mL (or within institutional normal range).
* Hepatitis C \*HCV antibody-negative.
* If HCV antibody-positive, HCV-RNA must be negative.
* Exclusion: Co-infection of HBV and HCV (HBsAg/HBcAb-positive and HCV antibody-positive).
* HIV Status HIV antibody-negative.
* Organ Function
Adequate organ function within 14 days before first dose (without transfusion, albumin, thrombopoietin, or CSF support):
\*Hematology: Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L Platelets ≥100 × 10⁹/L Hemoglobin ≥90 g/L
\*Liver: Total bilirubin ≤1.5 × ULN AST/ALT ≤2.5 × ULN (≤5 × ULN if liver metastases present) Alkaline phosphatase ≤5.0 × ULN Albumin ≥25 g/L
\*Renal: Creatinine clearance ≥50 mL/min (Cockcroft-Gault formula)
\*Coagulation: INR ≤1.5 × ULN APTT ≤1.5 × ULN PT ≤1.5 × ULN
* Contraception
* Females of childbearing potential: Negative serum pregnancy test within 7 days before first dose.
* All participants: Use of ≥1 medically approved contraceptive method (e.g., IUD, oral contraceptives, barrier devices) during treatment and for ≥7 months after last dose.
Exclusion Criteria:
* Other Malignancies
History of other malignancies within 2 years prior to first dose, except:
Curatively treated localized tumors (e.g., basal cell carcinoma, squamous cell carcinoma of skin, superficial bladder cancer, carcinoma in situ of prostate/cervix/breast/thyroid).
* Prior Anthracycline Exposure
Cumulative doxorubicin dose \> 360 mg/m² (or equivalent):
Equivalent agents: Epirubicin \>720 mg/m², mitoxantrone \>120 mg/m², idarubicin \>90 mg/m², or liposomal doxorubicin \>360 mg/m² doxorubicin-equivalent.
If multiple anthracyclines were used, the total cumulative dose must not exceed 360 mg/m² doxorubicin-equivalent.
* Prior HER2-Targeted Therapy Any previous HER2-targeted treatment (e.g., trastuzumab, pertuzumab).
* Active Gastrointestinal Bleeding
≥ Grade 2 toxicity per NCI-CTCAE v5.0.
* CNS Involvement Central nervous system (CNS) metastases and/or leptomeningeal metastases.
* Cardiovascular Events
History within 6 months prior to first dose:
Cerebrovascular accident, myocardial infarction, unstable angina, or poorly controlled arrhythmias.
QTc interval ≥450 ms (males) or ≥470 ms (females) (Fridericia formula).
* Cardiac Dysfunction NYHA Class III-IV heart failure or left ventricular ejection fraction (LVEF) \< 55% by echocardiography.
* Pulmonary/Infectious Conditions Interstitial lung disease (current or history). Active infection requiring systemic therapy or active tuberculosis.
* Recent Live Vaccines Administration of live attenuated vaccines within 28 days prior to first dose (exception: inactivated influenza or COVID-19 vaccines).
* Major Surgery Within 28 days prior to first dose.
* Radiotherapy Curative radiotherapy within 28 days prior to first dose.
* Concurrent Clinical Trials Current participation in other interventional studies or use of investigational drugs/devices within 28 days prior to first dose.
* Hypersensitivity Known severe allergy to monoclonal antibodies or excipients of the study drugs.
* Substance Abuse History of illicit drug use or psychiatric medication abuse.
* Pregnancy/Lactation Pregnant or breastfeeding women.
* Other Exclusionary Factors
Any condition deemed by the investigator to:
Compromise patient safety or data integrity. Require concomitant treatment for severe comorbidities (including psychiatric disorders).
Exhibit critically abnormal laboratory values. Pose significant social/familial impediments to study completion.
Locations (2)
Nanjing Drum Tower Hospital
Nanjing, Nanjing, China
Zhongshan Hospital, Fudan University
Shanghai, Shanghai Municipality, China
Outcomes
Primary Outcomes
Objective Response Rate (ORR) assessed by investigators per RECIST v1.1.