Surgical resection after TNFerade™ therapy for locally advanced pancreatic cancer

Context: Treatment of pancreatic cancer remains a major oncological challenge and survival is dismal. Most patients, present with advanced disease at diagnosis and are not candidates for curative resection. Preoperative chemoradiation may downstage and improve survival in locally advanced pancreatic cancer. This has prompted investigators to look for novel neoadjuvant therapies. Gene therapy for pancreatic cancer is a novel investigational approach that may have promise. TNFerade™ is a replication deficient adenovirus vector carrying the human tumor necrosis factor (TNF)-alpha gene regulated under control of a radiation-inducible gene promoter. Transfection of tumor cells with TNFerade™ maximizes the antitumor effect of TNF-alpha under influence of radiation leading to synergistic effects in preclinical studies. Case report: We describe a case of locally advanced unresectable pancreatic cancer treated with a novel multimodal approach utilizing gene therapy with TNFerade™ and concurrent chemoradiation that was followed by successful surgical resection. Conclusion: Neoadjuvant TNFerade™ based chemoradiation therapy may be a useful adjunct to treatment of locally advanced pancreatic cancer.