Atiq Saad, Atiq Osman O, Atiq Zainab O, Samad Syed, Atiq Omar
Internal Medicine, Duke University Medical Center, Durham, USA.
Internal Medicine, Unity Health System, Searcy, USA.
Cureus. 2021 Feb 4;13(2):e13133. doi: 10.7759/cureus.13133.
Among the various types of cancer, pancreatic cancer is considered to have a particularly grim prognosis. Treatment includes surgery, chemotherapy, or both. While the role of immunotherapy is well-studied in many types of cancer, such is not the case with pancreatic cancer. A 49-year-old female presented to the oncology clinic following a biopsy of a pancreatic mass. CT-guided needle biopsy of the mass demonstrated moderately differentiated pancreatic adenocarcinoma. Positive emission tomography-computed tomography (PET-CT) revealed metastases to the liver. She was started on chemotherapy with FOLFIRINOX (leucovorin calcium, 5-fluorouracil, irinotecan hydrochloride, oxaliplatin) and demonstrated over 60% reduction in the size of liver metastases within three months. PET-CT four months after initiation of chemotherapy revealed no focal avid fluorodeoxyglucose (FDG) uptake in the liver, and the pancreatic body mass was stable in size at 3.0 cm with stable standardized uptake value (SUV) max at 2.4, only slightly elevated from 1.9 on the previous scan. Further treatment with chemotherapy was halted after 18 cycles due to side effects. With the patient's tumor being epidermal growth factor receptor (EGFR) negative, mismatch repair (MMR) negative, 3% tumor cells PD-L1 positive with 10% tumor-associated immune cells positive, treatment with pembrolizumab was started. Follow-up PET-CTs over the next several months confirmed the patient was in complete remission from metastatic pancreatic cancer. At the time of the report, the patient had a durable response of three years. We report a rare case of complete remission of metastatic pancreatic adenocarcinoma treated with chemotherapy, followed by immunotherapy. With emerging targets for modification of tumor microenvironment, immunotherapy must be further explored in the treatment of pancreatic cancer.
在各类癌症中，胰腺癌的预后被认为尤其严峻。治疗方法包括手术、化疗或两者结合。虽然免疫疗法在多种癌症中的作用已得到充分研究，但在胰腺癌中并非如此。一名49岁女性在胰腺肿块活检后前往肿瘤诊所就诊。对该肿块进行CT引导下针吸活检，结果显示为中度分化的胰腺腺癌。正电子发射断层扫描-计算机断层扫描（PET-CT）显示有肝转移。她开始接受FOLFIRINOX（亚叶酸钙、5-氟尿嘧啶、盐酸伊立替康、奥沙利铂）化疗，三个月内肝转移灶大小缩小超过60%。化疗开始四个月后的PET-CT显示肝脏内无局灶性氟脱氧葡萄糖（FDG）摄取增高，胰体部肿块大小稳定在3.0 cm，标准化摄取值（SUV）最大值稳定在2.4，仅比上一次扫描的1.9略有升高。由于副作用，18个周期后停止进一步化疗。鉴于患者肿瘤为表皮生长因子受体（EGFR）阴性、错配修复（MMR）阴性、3%肿瘤细胞PD-L1阳性且10%肿瘤相关免疫细胞阳性，开始使用帕博利珠单抗治疗。接下来几个月的随访PET-CT证实患者的转移性胰腺癌完全缓解。在报告时，患者有三年的持久缓解期。我们报告了一例罕见的转移性胰腺腺癌经化疗后再行免疫治疗实现完全缓解的病例。随着肿瘤微环境修饰的新靶点不断涌现，免疫疗法在胰腺癌治疗中必须进一步探索。
