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This combination therapy consists of **nivolumab**, a programmed death-1 (PD-1) immune checkpoint inhibitor, and **all-trans retinoic acid (ATRA)**, a small molecule retinoid derivative of vitamin A. Investigated by **China Medical University Hospital**, the regimen is being evaluated for the treatment of chemotherapy-refractory advanced or metastatic **pancreatic adenocarcinoma**. ATRA acts as a stromal targeting agent and a repressor of **adenosine deaminase acting on RNA 1 (ADAR1)**. By suppressing ADAR1, ATRA triggers interferon-α signaling and induces PD-L1 expression on cancer cells. This modulation of the tumor microenvironment is intended to overcome resistance to checkpoint inhibitor therapy, allowing nivolumab to more effectively block the PD-1/PD-L1 interaction and enhance the anti-tumor immune response.
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