Tao Yiying, Tang Lei, Zuo Li, Ma Yue, Zhang Fengchun, Xu Yingchun
Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China.
Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu 215000, P.R. China.
Oncol Lett. 2022 Aug 17;24(4):344. doi: 10.3892/ol.2022.13464. eCollection 2022 Oct.
Pancreatic cancer (PC) is a fatal disease with a high mortality rate due to difficulties in early diagnosis and metastasis. Common sites of metastasis from PC include the liver, lung, stomach and kidney. Patients diagnosed at already the metastatic stages on presentation constitute 50-55% of the cases, with a 5-year survival rate of 3%. By contrast, secondary ovarian metastases account for 10-25% of all ovarian malignancies, though an accurate diagnosis remain challenging. The present study reports the rare case of a 42-year-old woman with primary hepatic metastasis and secondary ovarian metastasis from PC treated with two lines of immunotherapy, who is also experiencing severe treatment-associated toxicity. The patient first received combined immunotherapy consisting of camrelizumab (200 mg; day 1; every 3 weeks) and chemotherapy with nab-paclitaxel (125 mg/m; days 1 and 8; every 3 weeks) and gemcitabine (1,000 mg/m; days 1 and 8; every 3 weeks). She then exhibited a partial response following 4 months of treatment. However, 9 months after the initial treatment, the disease progressed with ovarian involvement, which was confirmed by surgery. Second-line treatment included immunotherapy, targeted therapy and oral chemotherapy (200 mg sintilimab on day 1; 50 mg tegafur from days 1-14, twice daily; and 8 mg anlotinib from days 1-14, every 3 weeks). The progression-free survival time from this second-line treatment was 6 months. Immunotherapy was permanently aborted due to severe intestinal inflammation, where four lines of combined treatments were recommended. The patient remains on treatment with a good quality of life in July 2022, and a current overall survival time of >24 months. In conclusion, the diagnosis of metastatic PC leads to a poor prognosis, but ovarian metastasis from PC is rare. Furthermore, the combination of immunotherapy with chemotherapy or antiangiogenic inhibitors shows promise as a treatment strategy for advanced stages of PC.
胰腺癌（PC）是一种致命疾病，由于早期诊断困难和易发生转移，死亡率很高。PC常见的转移部位包括肝脏、肺、胃和肾脏。初诊时已处于转移阶段的患者占病例的50-55%，5年生存率为3%。相比之下，卵巢转移瘤占所有卵巢恶性肿瘤的10-25%，尽管准确诊断仍具有挑战性。本研究报告了一例罕见病例，一名42岁女性患有PC的原发性肝转移和继发性卵巢转移，接受了两线免疫治疗，同时还出现了严重的治疗相关毒性。患者首先接受了由卡瑞利珠单抗（200mg；第1天；每3周一次）以及白蛋白结合型紫杉醇（125mg/m²；第1天和第8天；每3周一次）和吉西他滨（1000mg/m²；第1天和第8天；每3周一次）组成的联合免疫治疗。治疗4个月后，她出现了部分缓解。然而，初始治疗9个月后，疾病进展并累及卵巢，手术证实了这一点。二线治疗包括免疫治疗、靶向治疗和口服化疗（第1天使用200mg信迪利单抗；第1-14天使用50mg替加氟，每日两次；每3周一次，第1-14天使用8mg安罗替尼）。二线治疗的无进展生存期为6个月。由于严重的肠道炎症，免疫治疗被永久中止，建议进行四线联合治疗。患者在2022年7月仍在接受治疗，生活质量良好，目前总生存期>24个月。总之，转移性PC的诊断预后较差，但PC的卵巢转移很少见。此外，免疫治疗与化疗或抗血管生成抑制剂联合使用作为PC晚期的治疗策略显示出前景。
