Pre-Surgery Immuno-Chemo Shows Promise for Pancreatic Cancer

UCLA study finds adding immunotherapy to standard chemotherapy before surgery is safe and shows promise for some patients with borderline-resectable pancreatic cancer.

Published on Feb. 20, 2026

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A new UCLA investigator-initiated study sponsored by the UCLA Health Jonsson Comprehensive Cancer Center has found that adding immunotherapy to standard chemotherapy before surgery is safe and shows promise for some patients with borderline-resectable pancreatic cancer, a disease that has historically been difficult to treat. While the combination did not produce a clear survival advantage for most patients, a notable subset experienced unusually deep and durable responses, including complete tumor regression and long-term disease control.

Why it matters

Pancreatic cancer remains one of the deadliest cancers, with few effective treatment options and limited benefit from immunotherapy. By focusing on patients with borderline-resectable disease, this study provides an opportunity to evaluate whether immunotherapy can improve surgical success and survival, while also revealing how the tumor's immune environment responds. These insights could help guide the development of more effective, tailored treatment strategies for a cancer that urgently needs better options.

The details

Researchers conducted a single-arm Phase 1b/2 clinical trial in 28 patients with borderline-resectable pancreatic cancer. Patients received modified FOLFIRINOX chemotherapy combined with the immunotherapy drug nivolumab before surgery. Most patients tolerated the combination treatment well and were able to proceed to surgery, with no serious immune-related side effects or treatment-related delays. While overall survival outcomes were similar to those typically achieved with chemotherapy alone, a subset of patients experienced unusually strong and durable responses, including 9% with complete disappearance of detectable cancer at the time of surgery and another 9% with near-complete responses.

  • The study was published in Nature Communications on February 18, 2026.

The players

UCLA Health Jonsson Comprehensive Cancer Center

The UCLA Health Jonsson Comprehensive Cancer Center sponsored the investigator-initiated study.

Dr. Timothy Donahue

The senior author of the study, who is the chief of surgical oncology and professor of surgery at the David Geffen School of Medicine at UCLA.

Dr. Zev Wainberg

The study's first author, who is the co-director of the UCLA Health GI Oncology Program.

Dr. Jason Link

The study's first author, who is an associate professor of surgery at the David Geffen School of Medicine at UCLA.

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What they’re saying

“By testing this novel drug combination in the preoperative setting, we were able to directly compare pre-treatment biopsies with surgical resection specimens to better understand why the therapy works in some patients, and, just as importantly, why it does not in others, and what additional strategies might improve responses.”

— Dr. Timothy Donahue, Chief of surgical oncology and professor of surgery at the David Geffen School of Medicine at UCLA (Mirage News)

What’s next

Future research will focus on identifying patients most likely to benefit from this combination therapy and developing strategies that better support effective, sustained anti-tumor immune responses.

The takeaway

While adding immunotherapy to standard chemotherapy did not produce a clear survival advantage for most patients with borderline-resectable pancreatic cancer, a subset of patients experienced unusually deep and durable responses, suggesting that immunotherapy may benefit select individuals. The study also provides important insight into why immune-based treatments have shown limited success in pancreatic cancer, revealing that while immunotherapy activates immune cells within tumors, it may also disrupt immune organization and promote immune exhaustion.