pegargiminase + nab-paclitaxel + gemcitabine

This drug is a combination regimen consisting of pegargiminase (ADI-PEG20), nab-paclitaxel (nanoparticle albumin-bound paclitaxel), and gemcitabine. Pegargiminase is a pegylated recombinant arginine deiminase enzyme that depletes arginine, an amino acid essential for the survival of certain cancer cells—especially those deficient in argininosuccinate synthetase 1 (ASS1). Nab-paclitaxel is a microtubule inhibitor formulated as nanoparticles bound to albumin, and gemcitabine is a nucleoside analog inhibiting DNA synthesis. While pegargiminase-based combinations have been studied most prominently with platinum-pemetrexed doublets for nonepithelioid mesothelioma, preclinical and early-phase clinical studies have explored combining pegargiminase with other chemotherapies, including nab-paclitaxel and gemcitabine, in arginine-auxotrophic tumors. This regimen aims to exploit metabolic vulnerabilities in ASS1-deficient cancers, leveraging both arginine depletion and cytotoxic chemotherapy for enhanced tumor control.