Al-Sukhun Sana, Khalidi Karim
Al Hyatt Oncology Practice, 40 Ibn Khaldoon Street, Amman 11183, Jordan.
Radiology Department, Al Khalidi Hospital & Medical Centre, 40 Ibn Khaldoon Street, Amman 11183, Jordan.
Ecancermedicalscience. 2023 Apr 21;17:1535. doi: 10.3332/ecancer.2023.1535. eCollection 2023.
Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery (median survival: <30 months). The prognosis of borderline resectable pancreatic cancer (BR-PDC) is even worse. We describe a patient with BR-PDC who achieved stable disease with metronomic chemotherapy after refusing surgery.
A 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, Fine needle aspiration (FNA) confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy. After the second cycle of mFOLFIRINOX - complicated by febrile neutropenia - she refused further IV therapy. Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis. The patient did well and she is currently alive with a stable disease as of 2 years after diagnosis.
Metronomic chemotherapy, especially capecitabine added to the targeted therapy, imatinib, is a potentially useful treatment for PDC where no other options are available, especially those harbouring no mutation in the dominant four genes. Indeed, the absence of mutation with KIT amplification could be a potential marker for improved outcomes with targeted and metronomic therapy, which deserves further evaluation in a clinical trial setting.
胰腺导管癌（PDC）的诊断颇具挑战性，预后尤其差，即便接受了根治性手术（中位生存期：<30个月）。临界可切除胰腺癌（BR-PDC）的预后更差。我们描述了一名BR-PDC患者，其在拒绝手术后通过节拍化疗实现了疾病稳定。
一名75岁女性出现黄疸和上腹部疼痛。影像学检查证实胰头部有一肿块，包绕肠系膜上静脉，伴有胰管和胆管梗阻。在置入支架解除梗阻后，细针穿刺抽吸（FNA）确诊为PDC。患者拒绝手术和放疗，但同意化疗。在接受了第二个周期的mFOLFIRINOX化疗（并发发热性中性粒细胞减少症）后，她拒绝进一步的静脉治疗。基因检测显示KIT扩增。因此，她开始使用伊马替尼治疗，临床和生化指标均有显著改善，表现为糖类抗原19-9下降。然而，这种反应仅持续了3个月。因此，在交替每周的基础上，低剂量（1g，每日两次）添加了卡培他滨。患者情况良好，截至诊断后2年，目前仍存活且疾病稳定。
节拍化疗，尤其是在靶向治疗伊马替尼基础上加用卡培他滨，对于没有其他治疗选择的PDC患者，特别是那些在四个主要基因中无突变的患者，可能是一种有效的治疗方法。事实上，存在KIT扩增但无突变可能是靶向治疗和节拍化疗改善预后的潜在标志物，这值得在临床试验中进一步评估。
