{Reference Type}: Case Reports
{Title}: PRaG 3.0 therapy for human epidermal growth factor receptor 2-positive metastatic pancreatic ductal adenocarcinoma: A case report.
{Author}: Kong YH;Xu ML;Zhang JJ;Chen GQ;Hong ZH;Zhang H;Dai XX;Ma YF;Zhao XR;Zhang CY;Chen RZ;Xing PF;Zhang LY;
{Journal}: World J Gastroenterol
{Volume}: 30
{Issue}: 9
{Year}: 2024 Mar 7
{Factor}: 5.374
{DOI}: 10.3748/wjg.v30.i9.1237
{Abstract}: <B>BACKGROUND: </B>Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal disease with limited effective treatment especially after first-line chemotherapy. The human epidermal growth factor receptor 2 (HER-2) immunohistochemistry (IHC) positive is associated with more aggressive clinical behavior and shorter overall survival in PDAC.<BR><B>METHODS: </B>We present a case of multiple metastatic PDAC with IHC mismatch repair proficient but HER-2 IHC weakly positive at diagnosis that didn't have tumor regression after first-line nab-paclitaxel plus gemcitabine and PD-1 inhibitor treatment. A novel combination therapy PRaG 3.0 of RC48 (HER2-antibody-drug conjugate), radiotherapy, PD-1 inhibitor, granulocyte-macrophage colony-stimulating factor and interleukin-2 was then applied as second-line therapy and the patient had confirmed good partial response with progress-free-survival of 6.5 months and overall survival of 14.2 month. She had not developed any grade 2 or above treatment-related adverse events at any point. Percentage of peripheral CD8+Temra and CD4+Temra were increased during first two activation cycles of PRaG 3.0 treatment containing radiotherapy but deceased to the baseline during the maintenance cycles containing no radiotherapy.<BR><B>CONCLUSIONS: </B>PRaG 3.0 might be a novel strategy for HER2-positive metastatic PDAC patients who failed from previous first-line approach and even PD-1 immunotherapy but needs more data in prospective trials.