Sato Ryosuke, Hotta Katsuyuki, Kubo Toshio, Horiguchi Shigeru, Kato Hironari, Matsumoto Kazuyuki, Kozuki Toshiyuki, Udono Heiichiro, Kiura Katsuyuki, Otsuka Motoyuki
Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, JPN.
Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, JPN.
Cureus. 2025 Feb 14;17(2):e79001. doi: 10.7759/cureus.79001. eCollection 2025 Feb.
We report a case of poorly differentiated pancreatic cancer that showed an exceptional response to combination therapy with nivolumab and metformin. A 58-year-old man presented with epigastric pain and was diagnosed with locally advanced pancreatic cancer with para-aortic lymph node metastasis. After disease progression following modified FOLFIRINOX therapy (a combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin), the patient was enrolled in a phase Ib clinical trial of nivolumab (3 mg/kg biweekly) combined with metformin (750 mg/day). Post-treatment imaging showed marked tumor shrinkage with normalization of the tumor markers. During treatment, the patient was diagnosed with early-stage lung cancer and underwent successful left S1+S2 segmentectomy with temporary suspension of immunotherapy. The therapeutic response of pancreatic cancer has been sustained for seven years, with minimal residual disease. This unprecedented response duration is particularly noteworthy considering his microsatellite stability, which typically predicts a limited response to immune checkpoint inhibition. This case demonstrates an exceptional response to nivolumab and metformin combination therapy in poorly differentiated pancreatic cancer. The remarkable durability of the response suggests the need for further investigation to identify patients most likely to benefit from this therapeutic approach.
我们报告了一例低分化胰腺癌患者，该患者对纳武单抗和二甲双胍联合治疗表现出异常反应。一名58岁男性因上腹部疼痛就诊，被诊断为伴有主动脉旁淋巴结转移的局部晚期胰腺癌。在改良FOLFIRINOX疗法（氟尿嘧啶、亚叶酸钙、伊立替康和奥沙利铂联合）治疗后疾病进展，该患者参加了一项纳武单抗（每两周3 mg/kg）联合二甲双胍（每日750 mg）的Ib期临床试验。治疗后的影像学检查显示肿瘤明显缩小，肿瘤标志物恢复正常。治疗期间，该患者被诊断为早期肺癌，并成功接受了左S1+S2段切除术，同时暂时停用免疫治疗。胰腺癌的治疗反应持续了七年，残留疾病极少。考虑到其微卫星稳定性，这种前所未有的反应持续时间尤其值得注意，因为微卫星稳定性通常预示着对免疫检查点抑制的反应有限。该病例证明了低分化胰腺癌对纳武单抗和二甲双胍联合治疗有异常反应。这种显著的反应持久性表明需要进一步研究，以确定最有可能从这种治疗方法中获益的患者。
