Phase 1 repurposed pentamidine + mFOLFIRINOX in PDAC

University of Oklahoma is running this Phase 1, two-arm, first-line study in advanced/metastatic or unresectable locally advanced pancreatic ductal adenocarcinoma to compare modified FOLFIRINOX alone (oxaliplatin platinum DNA-damager + irinotecan topoisomerase I inhibitor + leucovorin biomodulator + infusional 5-FU thymidylate synthase inhibitor) versus the same regimen with added IV pentamidine. Pentamidine is an antimicrobial/antiprotozoal small molecule; its anti-cancer mechanism is not established as a single, specific oncology target, so the trial’s practical focus is whether adding it to a high-activity chemotherapy backbone is tolerable and shows any signal of improved disease control. Eligible patients are treatment-naive with measurable, unresectable PDAC, a population where the real-world first-line standard is multi-agent chemo such as modified FOLFIRINOX or gemcitabine plus nab-paclitaxel, followed by subsequent-line regimens (including 5-FU–based combinations) as tolerated. Commercially, the interesting angle is drug repurposing: testing a low-cost, already-known agent alongside a standard intensive regimen, with an early “safety-first” design that could justify a larger efficacy-focused expansion if signals appear.