Amol Akhade: Can We Tackle Cachexia and Improve Survival in Advanced Pancreatic Cancer By Blocking IL-6?
Amol Akhade, Consultant Medical Oncologist at Suyog Cancer Clinics, shared on LinkedIn about a recent paper by Inna M. Chen et al. published in Journal of Clinical Oncology:
“Can we tackle cachexia and improve survival in advanced pancreatic cancer by blocking IL-6?
A new Phase II randomized trial (Chen et al., JCO May 2025) tested the addition of tocilizumab (anti–IL-6 receptor antibody) to standard gemcitabine/nab-paclitaxel in patients with advanced pancreatic cancer.
Here’s what we learned:
Key findings
- Reduced muscle loss with tocilizumab (anticachexia effect)
- Primary endpoint (6-month OS) not met (68.6% vs 62%, P = 0.409)
- Median OS was similar (8.4 vs 8.0 months, P = 0.096)
- No improvement in PFS or ORR
- Toxicity increased: Grade 3+ adverse events were 88% vs 63%
- GDF15 levels remained unchanged (IL-6 effect appears independent)
What raised eyebrows?
The authors highlight a significant 18-month OS difference (27% vs 7%, P = 0.001), despite no difference in median OS or response rates.
While interesting, this late survival signal was not a predefined endpoint, raising the possibility of spin and post hoc bias.
So, what’s the bottom line?
This study doesn’t change practice—but it opens doors for precision cachexia therapies. IL-6 blockade might benefit a biomarker-selected subgroup, particularly those with elevated inflammatory markers.
Still, the increased toxicity and lack of tumor control benefit temper the enthusiasm.
Verdict:
- Negative trial for survival
- Hypothesis-generating for cachexia
- Not practice-changing – for now”
Title: Randomized Phase II Study of Nab-Paclitaxel and Gemcitabine With or Without Tocilizumab as First-Line Treatment in Advanced Pancreatic Cancer: Survival and Cachexia
Authors: Inna M. Chen, Julia S. Johansen, Susann Theile, Libbie M. Silverman, Katherine R. Pelz, Kasper Madsen, Olav Dajani, Kevin Z.M. Lim, Torben Lorentzen, Omnia Gaafer, Leonidas G. Koniaris, Anna C. Ferreira, Brian Neelon, Denis C. Guttridge, Michael C. Ostrowski, Teresa A. Zimmers, Dorte Nielsen
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