Associate Professor Dan Croagh is a pancreatic surgeon and interventional endoscopist at Monash Medical Centre, Victoria. He is Study Chair of the PemOla trial, alongside Associate Professor Sumitra Ananda.
PemOla is investigating the combination of immunotherapy and a PARP inhibitor – a targeted therapy – for people with metastatic pancreatic cancer with high tumour mutational burden. This tumour type has a substantial number of genetic changes.
Read on for a deep dive into the science behind the PemOla study – excitingly, now open!
The premise
“There’s been a lot of work in trying to bring precision medicine to pancreatic cancer, but it’s a really challenging space,” asserts Dan. “Survival for people with locally advanced and metastatic disease is between 6 and 12 months – you don’t have a lot of time.”
After a pathologist processes someone’s biopsy to make the diagnosis itself, what’s left is usually thrown away. “But we can sequence that fluid,” says Dan. “It’s called a supernatant. So now we can say, ‘Look, your biopsy’s come back showing cancer. The pathology lab still has the supernatant, are you happy for us to obtain that supernatant?’”
In a past clinical trial Dan was part of, virtually every participant was able to have their tumours sequenced this way.
“Approximately 20% of patients with pancreatic cancer have a mutation that might be amenable to a targeted therapy, but only 5% have been able to get onto targeted therapies.
“If the cancer is particularly mutated, then it’s very likely that those patients will respond very well to immunotherapy,” Dan says.
The idea
“One of our early patients had what’s called a germline mutation, in a gene that predisposes them to pancreatic and breast cancer.
“When we discovered that, the patient started on both immunotherapy and a PARP inhibitor. He did exceptionally well – he had 20 liver metastases that have all disappeared on treatment.”
That was when Dan came across a study proposed by Dr Pippa Corrie at Cambridge, UK, which aimed to look at the same combination. This proposal became the PemOla trial.
The innovation
PemOla is a combination therapy trial using an immunotherapy and a targeted therapy agent called a PARP inhibitor.
By bringing PemOla to life in Australia, we’re able to bring this innovative treatment to Australians with pancreatic cancer, including providing access to the cutting-edge medicine.
“It’s different to conventionally available treatments – it’s not a cytotoxic chemotherapy, it harnesses the patient’s own immune system.
“It’s a completely different approach to pancreatic cancer, although it has been extensively used to great effect in other cancers.”
PemOla is funded by our generous community of supporters, and is also the recipient of prestigious grants from Tour de Cure, Epworth Medical Foundation and PanKind, The Australian Pancreatic Cancer Foundation.
“I can’t thank the community enough,” says Associate Professor Croagh. “PemOla could change the future of treatment for patients who currently have no options left.”
Learn more about the PemOla trial
This article was featured in The Digest, Issue 4, 2025.
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