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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

March 2013. Tumor lesions in the primary tumor and lymph nodes after 2 cycles of nab-paclitaxel plus gemcitabine. 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 2: March 2013. Tumor lesions in the primary tumor and lymph nodes after 2 cycles of nab-paclitaxel plus gemcitabine. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.

Mentions: Three weeks after surgery, intensified neoadjuvant chemotherapy was started with the objective to achieve secondary resectability. The patient was given 2 cycles of a combination of nab-paclitaxel plus gemcitabine. Nab-paclitaxel was given at a dose of 125 mg/m2 on days 1, 8 and 15, gemcitabine at a dose of 1,000 mg/m2 on days 1, 8 and 15, both repeated on day 29. Chemotherapy was tolerated well. The patient developed grade 2 neutropenia and grade 1 fatigue. Treatment resulted in a complete metabolic remission. The follow-up PET-CT showed no more PET-avid lesions (fig. 2).


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)

March 2013. Tumor lesions in the primary tumor and lymph nodes after 2 cycles of nab-paclitaxel plus gemcitabine. 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 2: March 2013. Tumor lesions in the primary tumor and lymph nodes after 2 cycles of nab-paclitaxel plus gemcitabine. a Fused PET-CT and PET of the primary tumor. b Fused PET-CT and PET of the regional lymph node metastases.
Mentions: Three weeks after surgery, intensified neoadjuvant chemotherapy was started with the objective to achieve secondary resectability. The patient was given 2 cycles of a combination of nab-paclitaxel plus gemcitabine. Nab-paclitaxel was given at a dose of 125 mg/m2 on days 1, 8 and 15, gemcitabine at a dose of 1,000 mg/m2 on days 1, 8 and 15, both repeated on day 29. Chemotherapy was tolerated well. The patient developed grade 2 neutropenia and grade 1 fatigue. Treatment resulted in a complete metabolic remission. The follow-up PET-CT showed no more PET-avid lesions (fig. 2).

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