Recombinant tumor necrosis factor-thymosin-α1 in combination with polychemotherapy in a patient with pancreatic cancer (case report)

Background. Despite advances in recent years, treatment outcomes for pancreatic cancer remain modest. The search for ways to overcome the immune resistance of pancreatic cancer and the need to optimize treatment strategies have drawn attention to the potential combined use of chemotherapy and the cytokine gene therapy drug tumor necrosis factor-thymosin-α1 recombinant. Оbjective. To evaluate the efficacy and safety of therapy with tumor necrosis factor-thymosin-α1 recombinant in a patient with pancreatic cancer undergoing chemotherapy. Material and methods. Patient I., 52, presented to the clinic in August 2025 for stage III cT4N1M0 pancreatic cancer. A percutaneous biopsy of the pancreatic tumor was performed (August 5, 2025). The diagnosis was confirmed histologically, revealing ductal adenocarcinoma, G3. According to the immunohistochemistry study of August 15, 2025: BRCA1 wt, BRCA2 wt, PALB2 wt. The oncology board prescribed courses of chemotherapy with the FOLFIRINOX regimen. To reduce the likelihood and severity of undesirable side effects associated with chemotherapy, the patient sought simultaneous cytokine gene therapy. The patient's condition was monitored using the Karnofsky status, CEA, CA19-9, and tumor necrosis factor-alpha levels. Computed tomography with intravenous contrast was used to assess the tumor response to treatment according to RECIST 1.1 criteria. Results. The patient was prescribed cytokine gene therapy with tumor necrosis factor-thymosin-α1 recombinant (rTNF-α1) according to the regimen developed at the clinic. During combination therapy, the patient noted a gradual improvement in his overall well-being, a decrease in pain severity, and was able to not only perform feasible housework but also partially return to his professional activities. Treatment toxicity associated with the use of chemotherapy did not exceed grades 1-2 according to CTCAE 5.0 (nausea and grade 1-2 leukopenia). No additional side effects associated with the use of rTNF-α1 were noted. When assessing the tumor process according to RECIST 1.1 criteria, after 5 courses of cytokine gene therapy and 9 courses of chemotherapy, a partial response was achieved, a decrease in target lesions by 36,9% from the initial level was noted. The patient currently continues to receive combination therapy with rTNF-α1 and chemotherapy. The patient's survival from diagnosis is 7+ months. Conclusion. Further clinical studies are needed to determine the role of combination therapy with tumor necrosis factor-thymosin-α1 recombinant and chemotherapy in patients with pancreatic cancer.