A Phase Ib/II Clinical Study of Regorafenib Combined With Toripalimab and Albumin-bound Paclitaxel for the Third-line Treatment of Advanced Pancreatic Cancer

Inclusion criteria

• The patient fully understands this study, voluntarily participates and signs an informed consent form (ICF);
• Age ≥ 18 years old and ≤ 80 years old;
• Patients with unresectable/metastatic pancreatic cancer confirmed by histopathology;
• Imaging confirmation of tumor progression after previous first-line and second-line standard treatment;
• According to RECIST 1.1 criteria, patients must have at least one measurable target lesion;
• Eastern Cancer Collaboration Group (ECOG) Physical Fitness Status Score: 0-2 points;
• Expected survival time ≥ 2 months;
• Absolute neutrophil count (ANC) ≥ 1.5 × 10 \^ 9/L, platelets ≥ 100 × 10 \^ 9/L, and hemoglobin ≥ 90 g/L (No blood transfusion or blood products within 14 days prior to laboratory examination.
• Not treated with granulocyte colony-stimulating factor or other hematopoietic stimulating factors);
• Liver and kidney function: serum creatinine ≤ 1.5 times the upper limit of normal value; AST and ALT ≤ 2.5 times the upper limit of normal values (≤ 5 times the upper limit of normal values for patients with liver metastases); Total bilirubin ≤ 1.5 times the upper limit of normal value (≤ 3 times the upper limit of normal value for patients with liver metastasis);
• Women of childbearing age must undergo a pregnancy test (serum) within 7 days before enrollment, and the result must be negative, And willing to use appropriate contraception methods during the trial period and 6 months after the last administration of the trial drug.

Exclusion criteria

• Have hypersensitivity reactions to any research drug or its components;
• Concurrent serious uncontrolled infections or other serious uncontrolled accompanying diseases, moderate or severe kidney injury; (such as progressive infection, uncontrollable hypertension, diabetes, etc.);
• Heart function and disease meet one of the following conditions:
• Long QTc syndrome or QTc interval\>480 ms;
• Complete left bundle branch block, grade II or III atrioventricular block;
• Severe and uncontrolled arrhythmias requiring medication treatment;
• New York College of Cardiology classification ≥ III;
• Heart ejection fraction (LVEF) below 50%;
• History of myocardial infarction, unstable angina, and severe unstable ventricular arrhythmia within 6 months prior to recruitment or any other arrhythmia requiring treatment, history of clinically severe pericardial disease, or there may be electrocardiographic evidence of acute ischemic or active conduction system abnormalities.
• Active infection of hepatitis B and C (hepatitis B virus surface antigen is positive and hepatitis B virus DNA exceeds 1x103 copies/mL; Hepatitis C virus RNA exceeding 1x103 copies/mL).Asymptomatic chronic carriers of hepatitis B or hepatitis C excluded;
• Human immunodeficiency virus (HIV) infection (HIV antibody positive);
• Imaging confirms intestinal obstruction;
• Previously or currently suffering from other malignant tumors simultaneously (Except for non melanoma basal cell carcinoma and breast/cervical carcinoma in situ that have been effectively controlled and other malignant tumors that have been effectively controlled without treatment in the past five years);
• Pregnant and lactating women, as well as reproductive age patients who are unwilling to take contraceptive measures;
• Patients who require treatment for merging with other malignant tumors;
• History of pulmonary hemorrhage/hemoptysis ≥ grade 2 (defined as at least 2.5mL of bright red blood) within one month prior to the first administration;
• Within 6 months prior to the first administration, there are arterial embolism, severe bleeding (excluding bleeding caused by surgery), and a tendency for severe bleeding;
• Merge symptomatic brain metastases, meningeal metastases, spinal cord tumor invasion, and spinal cord compression syndrome;
• Have used other clinical trial drugs within one month before the first administration;
• The researchers have determined that patients who are not suitable to participate in this study.