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Bardoxolone methyl + gemcitabine is an investigational combination therapy comprising bardoxolone methyl, a synthetic oleanane triterpenoid and potent activator of the Nrf2 pathway, and gemcitabine, a nucleoside analog antimetabolite. Bardoxolone methyl induces transcription of antioxidant genes, suppresses oxidative stress and inflammation, and modulates tumor cell proliferation, apoptosis, and immune responses through mechanisms involving Nrf2 and other pathways. Gemcitabine, a cytidine analog, inhibits DNA synthesis, leading to apoptosis of proliferating cancer cells. The combination has been evaluated preclinically and in early-phase trials, including a phase I trial in stage II–IV pancreatic adenocarcinoma, with an emphasis on immune modulation and enhanced antitumor effects[3][2].
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