Kikuchi Koji, Umemura Akira, Nitta Hiroyuki, Katagiri Hirokatsu, Nishiya Masao, Uesugi Noriyuki, Sugai Tamotsu, Imanari Keisuke, Sasaki Akira
Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
Surg Case Rep. 2022 Oct 7;8(1):192. doi: 10.1186/s40792-022-01549-9.
Pancreatic cancer has one of the worst prognoses of any all cancers. 5-FU/leucovorin + irinotecan + oxaliplatin (FOLFIRINOX), gemcitabine (GEM) plus nab-paclitaxel regimens have been recognized as global-standard, first-line treatments for patients with advanced pancreatic cancer. The liposomal irinotecan (nal-IRI) + 5-FU/LV regimen is now included in treatment guidelines as a recommended and approved option for use in patients with metastatic pancreatic cancer that has progressed after GEM-based therapy and who have a suitable performance status and comorbidity profile. There is no report that nal-IRI + 5-FU/LV regimen was significantly effective, and we will report it because we experienced this time.
A 69-year-old man presented with epigastric pain, and a contrast computed tomography (CT) revealed an enhanced mass lesion measuring 33 × 27 mm on the pancreatic body with encasement of the common hepatic artery (CHA) and the splenic vein. An endoscopic ultrasound-guided fine needle aspiration was performed and demonstrated cytology consistent with adenocarcinoma. Therefore, we diagnosed the patient with unresectable locally advanced pancreatic cancer. The patient received the GEM and S-1 regimen; however, the adverse event was relatively severe. Then, 11 cycles of nal-IRI + 5-FU/LV regimen were administered. A CT scan revealed that the tumor had shrunk to 18 × 7 mm in diameter with encasement of the CHA. The encasement of the splenic vein had disappeared, without any distant metastases. From this post-chemotherapy evaluation and intraoperative frozen section of around the celiac artery, gastroduodenal artery and pancreas stump confirmed absence of tumor cells, we performed distal pancreatectomy with celiac axis resection. A histological examination of the surgical specimen revealed no evidence of residual adenocarcinoma, consistent with a pathological complete response to treatment.
We present the first case of a pathological complete response with nal-IRI + 5-FU/LV for unresectable, locally advanced pancreatic cancer. In the future, nal-IRI may become a key drug for pancreatic cancer treatment.
胰腺癌是所有癌症中预后最差的癌症之一。5-氟尿嘧啶/亚叶酸钙 + 伊立替康 + 奥沙利铂（FOLFIRINOX）、吉西他滨（GEM）联合纳米白蛋白结合型紫杉醇方案已被公认为晚期胰腺癌患者的全球标准一线治疗方案。脂质体伊立替康（nal-IRI） + 5-氟尿嘧啶/亚叶酸钙方案现已被纳入治疗指南，作为转移性胰腺癌患者在基于吉西他滨的治疗后病情进展且具有合适的体能状态和合并症情况时的推荐和批准使用选项。尚无报道称nal-IRI + 5-氟尿嘧啶/亚叶酸钙方案具有显著疗效，我们此次有相关经历，故予以报道。
一名69岁男性因上腹部疼痛就诊，对比增强计算机断层扫描（CT）显示胰体部有一个33×27毫米的强化肿块病变，包绕肝总动脉（CHA）和脾静脉。进行了内镜超声引导下细针穿刺抽吸，细胞学检查显示与腺癌相符。因此，我们诊断该患者为不可切除的局部晚期胰腺癌。患者接受了吉西他滨和S-1方案治疗；然而，不良事件相对严重。随后，给予11个周期的nal-IRI + 5-氟尿嘧啶/亚叶酸钙方案。CT扫描显示肿瘤直径缩小至18×7毫米，仍包绕肝总动脉。脾静脉的包绕消失，无任何远处转移。根据化疗后评估以及腹腔动脉、胃十二指肠动脉和胰腺残端周围的术中冰冻切片证实无肿瘤细胞，我们进行了联合腹腔干切除术的远端胰腺切除术。手术标本的组织学检查未发现残留腺癌的证据，与治疗的病理完全缓解一致。
我们报道了首例nal-IRI + 5-氟尿嘧啶/亚叶酸钙方案治疗不可切除的局部晚期胰腺癌获得病理完全缓解的病例。未来，nal-IRI可能成为胰腺癌治疗的关键药物。
