Cura Daball Paola, Tröger Hanno, Daum Severin
Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany.
Medizinische Klinik 1, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany.
Z Gastroenterol. 2022 Oct;60(10):1510-1516. doi: 10.1055/a-1695-3528. Epub 2021 Dec 14.
Pancreatic cancer is still considered one of the most aggressive types of cancer and is associated with a very poor prognosis although there have been improvements in diagnostics and chemotherapy regimes in recent years. A cure can only be achieved through complete resection which is only possible when diagnosed at a very early stage, though this is rarely the case. We report on a patient with stage IV adenocarcinoma of the pancreas in which several therapeutically actionable mutations could be detected and discuss new options of targeted therapies.
A patient in his 50s was diagnosed with metastatic adenocarcinoma of the pancreas. The patient showed an excellent response to platinum-based chemotherapy with FOLFIRINOX. When a germline mutation in the BRCA-2 gene could be identified, he took part in the POLO-study receiving a maintenance therapy with the PARP-Inhibitor Olaparib. Due to a relapse, 2nd and 3rd line chemotherapy regimens were applied with Gemcitabine combined with Nab-Paclitaxel and later with Erlotinib. Although an activating mutation in the KRAS-gene could be detected as well, the patient rejected further experimental treatment.
Identifying predictive factors and specific targetable mutations in patients with advanced pancreatic cancer is needed to be able to apply more individual and specific therapies in order to improve outcomes.
尽管近年来在诊断和化疗方案方面有所改进，但胰腺癌仍被认为是最具侵袭性的癌症类型之一，预后很差。只有通过完全切除才能实现治愈，而这只有在极早期诊断时才有可能，不过这种情况很少见。我们报告了一例IV期胰腺腺癌患者，在该患者中检测到了几种具有治疗可操作性的突变，并讨论了靶向治疗的新选择。
一名50多岁的患者被诊断为胰腺转移性腺癌。该患者对基于铂的FOLFIRINOX化疗表现出良好反应。当鉴定出BRCA - 2基因的种系突变时，他参加了POLO研究，接受PARP抑制剂奥拉帕利的维持治疗。由于复发，应用了二线和三线化疗方案，吉西他滨联合纳米白蛋白结合型紫杉醇，后来又联合厄洛替尼。尽管也检测到了KRAS基因的激活突变，但患者拒绝了进一步的实验性治疗。
需要确定晚期胰腺癌患者的预测因素和特定的可靶向突变，以便能够应用更个体化和特异性的治疗方法来改善治疗结果。
