Tiller Maximilian, Gundling Felix, Schepp Wolfgang, Fuchs Martin
Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Bogenhausen Academic, Teaching Hospital, Munich Municipal Hospital Trust. Munich, Germany.
JOP. 2015 Mar 20;16(2):205-8. doi: 10.6092/1590-8577/2962.
Pancreatic adenocarcinoma is one of the most lethal malignancies worldwide. In patients with unresectable tumor there are several strategies of palliative chemotherapy, either gemcitabine based regimens or FOLFIRINOX, which is supposed to be most efficient but also most toxic. Hence, management of toxicity is crucial to perform a therapy consisting of FOLFIRINOX.
We report on a 69-year-old female patient suffering from adenocarcinoma of the pancreatic tail with multiple liver metastases. Palliative chemotherapy comprising leucovorin, fluorouracil, oxaliplatin and irinotecan (FOLFIRINOX) was initiated in February 2011 and was tolerated very well. Subsequent computed tomography-scans showed significant reduction of the tumor load in the liver as well as in the primary pancreatic tumor. The serum levels of the tumor marker CA 19-9 were elevated initially and decreased concomitantly. Thus, chemotherapy was continued for more than 3 years, and up to 72 cycles were administered until April 2014. Due to intermittent neutropenia and mucositis the initial dose was reduced to 60% of the calculated standard dose. In April 2014, an intermediate staging by computed tomography and FDG-PET revealed significant reduction of the size of the primary pancreatic tumor compared with February 2011. Liver metastases could hardly be detected anymore. After pausing chemotherapy for 12 weeks, one liver metastasis reappeared and was treated by RFA in August 2014. Meanwhile, in October 2014 there is no radiological evidence on any existing tumor or metastasis.
Our report demonstrates that a sufficient tolerance of chemotherapy with FOLFIRINOX is achievable, what makes a long term treatment with FOLFIRINOX feasible and can lead to impressive results.
胰腺腺癌是全球最致命的恶性肿瘤之一。对于无法切除肿瘤的患者，有几种姑息化疗策略，即以吉西他滨为基础的方案或FOLFIRINOX方案，后者被认为是最有效的，但毒性也最大。因此，毒性管理对于实施由FOLFIRINOX组成的治疗至关重要。
我们报告了一名69岁女性患者，患有胰尾腺癌并伴有多处肝转移。2011年2月开始进行包括亚叶酸、氟尿嘧啶、奥沙利铂和伊立替康（FOLFIRINOX）的姑息化疗，患者耐受性非常好。随后的计算机断层扫描显示肝脏以及胰腺原发肿瘤的肿瘤负荷显著降低。肿瘤标志物CA 19-9的血清水平最初升高，随后随之下降。因此，化疗持续了3年多，直至2014年4月共进行了多达72个周期。由于间歇性中性粒细胞减少和粘膜炎，初始剂量减至计算标准剂量的60%。2014年4月，通过计算机断层扫描和FDG-PET进行的中期分期显示，与2011年2月相比，胰腺原发肿瘤的大小显著减小。几乎再也检测不到肝转移灶。在化疗暂停12周后，2014年8月出现了一个肝转移灶，并接受了射频消融治疗。与此同时，2014年10月，没有任何现有肿瘤或转移灶的影像学证据。
我们的报告表明，FOLFIRINOX化疗具有足够的耐受性是可以实现的，这使得FOLFIRINOX的长期治疗可行，并可取得令人印象深刻的结果。
