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Intensified Neoadjuvant Chemotherapy with Nab-Paclitaxel plus Gemcitabine Followed by FOLFIRINOX in a Patient with Locally Advanced Unresectable Pancreatic Cancer.

Kunzmann V, Herrmann K, Bluemel C, Kapp M, Hartlapp I, Steger U - Case Rep Oncol (2014)

Bottom Line: In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based.After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography.After a follow-up of 18 months the patient is alive without progression of disease.

View Article: PubMed Central - PubMed

Affiliation: Departments of Medical Oncology, University of Würzburg, Würzburg, Germany.

ABSTRACT
The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.

No MeSH data available.


Related in: MedlinePlus

January 2013. Tumor lesions in the primary tumor and lymph nodes prior to chemotherapy. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.
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Figure 1: January 2013. Tumor lesions in the primary tumor and lymph nodes prior to chemotherapy. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.

Mentions: In December 2012, a 46-year-old female patient presented to our center with jaundice. She was otherwise asymptomatic and in an excellent performance status. She reported no comorbidities and neither alcohol nor nicotine abuse nor prior diabetes mellitus. Family history concerning malignancies was also negative. Laboratory findings were typical of cholestasis with an elevated concentration of total serum bilirubin to 8.4 mg/dl. The level of the tumor marker CA 19-9 was increased to 171 U/ml. Abdominal ultrasound revealed a dilation of the ductus hepatocholedochus (DHC) but no detectable tumor mass. Endoscopic retrograde cholangiopancreatography showed a malignant stenosis of the DHC. A stent was placed into the DHC to allow biliary drainage, and as a result total serum bilirubin decreased to a normal value within a few days. Endosonography revealed a hypoechoic lesion in the pancreatic head between DHC and the portal vein in the vicinity of the celiac trunk as well as suspicious locoregional lymph nodes. There were, however, no tumor cells in the bioptic material gained repeatedly during this session. Integrated fludeoxyglucose (18F) positron emission tomography (PET)-computed tomography (CT) found a PET-avid tumor in the pancreatic head largely adjacent to the celiac trunk and a PET-avid regional lymph node metastasis (fig. 1). There were no signs of peritoneal carcinomatosis or distant metastasis. An exploratory laparotomy confirmed the diagnosis of PDAC by intraoperatively frozen sections and the suspected unresectability which was due to an encasement of the celiac trunk (>180°) by the pancreatic tumor. Histology detected a moderately differentiated pancreatic adenocarcinoma surrounded by stromal desmoplasia. Thus, the locally advanced PDAC could be classified as pT4 Nx cM0 G2. During surgery, the patient received a biliodigestive anastomosis using Roux-en-Y anastomosis and a central venous port system.


Intensified Neoadjuvant Chemotherapy with Nab-Paclitaxel plus Gemcitabine Followed by FOLFIRINOX in a Patient with Locally Advanced Unresectable Pancreatic Cancer.

Kunzmann V, Herrmann K, Bluemel C, Kapp M, Hartlapp I, Steger U - Case Rep Oncol (2014)

January 2013. Tumor lesions in the primary tumor and lymph nodes prior to chemotherapy. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4209279&req=5

Figure 1: January 2013. Tumor lesions in the primary tumor and lymph nodes prior to chemotherapy. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.
Mentions: In December 2012, a 46-year-old female patient presented to our center with jaundice. She was otherwise asymptomatic and in an excellent performance status. She reported no comorbidities and neither alcohol nor nicotine abuse nor prior diabetes mellitus. Family history concerning malignancies was also negative. Laboratory findings were typical of cholestasis with an elevated concentration of total serum bilirubin to 8.4 mg/dl. The level of the tumor marker CA 19-9 was increased to 171 U/ml. Abdominal ultrasound revealed a dilation of the ductus hepatocholedochus (DHC) but no detectable tumor mass. Endoscopic retrograde cholangiopancreatography showed a malignant stenosis of the DHC. A stent was placed into the DHC to allow biliary drainage, and as a result total serum bilirubin decreased to a normal value within a few days. Endosonography revealed a hypoechoic lesion in the pancreatic head between DHC and the portal vein in the vicinity of the celiac trunk as well as suspicious locoregional lymph nodes. There were, however, no tumor cells in the bioptic material gained repeatedly during this session. Integrated fludeoxyglucose (18F) positron emission tomography (PET)-computed tomography (CT) found a PET-avid tumor in the pancreatic head largely adjacent to the celiac trunk and a PET-avid regional lymph node metastasis (fig. 1). There were no signs of peritoneal carcinomatosis or distant metastasis. An exploratory laparotomy confirmed the diagnosis of PDAC by intraoperatively frozen sections and the suspected unresectability which was due to an encasement of the celiac trunk (>180°) by the pancreatic tumor. Histology detected a moderately differentiated pancreatic adenocarcinoma surrounded by stromal desmoplasia. Thus, the locally advanced PDAC could be classified as pT4 Nx cM0 G2. During surgery, the patient received a biliodigestive anastomosis using Roux-en-Y anastomosis and a central venous port system.

Bottom Line: In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based.After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography.After a follow-up of 18 months the patient is alive without progression of disease.

View Article: PubMed Central - PubMed

Affiliation: Departments of Medical Oncology, University of Würzburg, Würzburg, Germany.

ABSTRACT
The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.

No MeSH data available.


Related in: MedlinePlus