Shi Charles W, VanderMeer Thomas J, Pudusseri Anita
SUNY Upstate Medical University, Syracuse, USA.
Hematology Oncology Associates of CNY, Syracuse, USA.
Discov Oncol. 2025 Jan 9;16(1):26. doi: 10.1007/s12672-025-01756-4.
Pancreatic cancer is a highly aggressive malignancy with the majority of patients presenting at a late stage with unresectable or metastatic disease. Even with first line treatment, median survival is approximately 11 months in patients with advanced PDAC. This report details the unique case of a patient that presented with peritoneal metastases from an adenocarcinoma of the body of the pancreas, had a remarkable response to palliative chemotherapy and is alive without evidence of disease 12 months following cessation of all active treatment. The initial diagnosis was 4 years ago and extensive resection of the primary was completed 2 years ago. The patient was started on standard FOLFIRINOX chemotherapy regimen, completed 6 cycles, but stopped Oxaliplatin and Irinotecan due to neuropathy and fatigue, on November 5, 2020, and transitioned to 5-fluorouracil (5-FU) and leucovorin. There was radiographic response and a notable decrease in tumor marker CA 19-9. On July 12, 2022 he underwent a multivisceral resection that included a radical anterograde modular pancreatico-splenectomy, partial gastrectomy, and splenic flexure colectomy with primary anastomosis due to tumor involvement of the posterior stomach and splenic flexure. Surgical pathology noted a moderately differentiated, grade 2 tumor staged ypT2 N0 M0. He continued the same adjuvant regimen of 5-FU and leucovorin for approximately 9 months with no new or recurrent disease on imaging. His CA 19-9 decreased within normal range after surgery and has remained within the normal limits. He remains on active surveillance. Overall, barring clear availability for targeted therapies, a metastatic PDAC of the tail may be considered to have a better prognosis than previously considered. FOLFIRINOX is the ideal treatment if the patient has a high-performance status, and PRODIGE 35 recommends 8 minimum cycles. However, in our case, the patient only tolerated 6 cycles and was still highly responsive. Despite a stage IV diagnosis, the primary tumor was resected in order to mitigate the risk for mutation and progression. Although rare, greater hope for patients with PDAC of the tail with favorable tumor biology responsive to FOLFIRINOX may contribute to increased surgical resection rates and improve survival rates.
胰腺癌是一种侵袭性很强的恶性肿瘤，大多数患者就诊时已处于晚期，患有无法切除或转移性疾病。即使接受一线治疗，晚期胰腺导管腺癌（PDAC）患者的中位生存期约为11个月。本报告详细介绍了一例独特病例，该患者胰腺体部腺癌出现腹膜转移，对姑息化疗有显著反应，在停止所有积极治疗12个月后仍无疾病证据存活。最初诊断是在4年前，2年前完成了原发灶的广泛切除。患者开始使用标准的FOLFIRINOX化疗方案，完成了6个周期，但由于神经病变和疲劳于2020年11月停止使用奥沙利铂和伊立替康，转而使用5-氟尿嘧啶（5-FU）和亚叶酸钙。影像学检查有反应，肿瘤标志物CA 19-9显著下降。2022年7月12日，他接受了多脏器切除术，包括根治性顺行模块化胰脾切除术、部分胃切除术和脾曲结肠切除术并一期吻合，因为肿瘤累及胃后壁和脾曲。手术病理显示为中度分化、2级肿瘤，分期为ypT2 N0 M0。他继续使用相同的5-FU和亚叶酸钙辅助方案约9个月，影像学检查未发现新的或复发性疾病。他的CA 19-9在术后降至正常范围并一直保持在正常限度内。他仍在接受积极监测。总体而言，除非有明确的靶向治疗可用，否则胰尾转移性PDAC的预后可能比之前认为的要好。如果患者体能状态良好，FOLFIRINOX是理想的治疗方法，PRODIGE 35建议至少8个周期。然而，在我们的病例中，患者仅耐受6个周期且仍有高度反应。尽管诊断为IV期，但为了降低突变和进展风险，仍切除了原发肿瘤。尽管罕见，但对于胰尾PDAC且肿瘤生物学特性良好、对FOLFIRINOX有反应的患者，更大的希望可能有助于提高手术切除率并改善生存率。
