{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:16:01Z","timestamp":1787026561184,"version":"build-2736575974"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1652827","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T05:36:35Z","timestamp":1759210595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of cadonilimab in combination with nimotuzumab and AG regimen in TMB-H\/KRAS wild-type advanced pancreatic cancer: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhiwei","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiegang","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhongShi","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongdong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2023.02.014","article-title":"Pancreatic cancer: Advances and challenges","volume":"186","author":"Halbrook","year":"2023","journal-title":"Cell."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.02630","article-title":"Nimotuzumab plus gemcitabine for K-ras wild-type locally advanced or metastatic pancreatic cancer","volume":"41","author":"Qin","year":"2023","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011923","article-title":"FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer","volume":"364","author":"Conroy","year":"2011","journal-title":"New Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1304369","article-title":"Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine","volume":"369","author":"Von Hoff","year":"2013","journal-title":"New Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25393","article-title":"Molecular predictors of outcome in a phase 3 study of gemcitabine and erlotinib therapy in patients with advanced pancreatic cancer: National Cancer Institute of Canada Clinical Trials Group Study PA","volume":"116","author":"da Cunha Santos","year":"2010","journal-title":"3. 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