Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6384-6390
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6384
Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection
Sophie Schneitler, Patric Kröpil, Jasmin Riemer, Gerald Antoch, Wolfram Trudo Knoefel, Dieter Häussinger, Dirk Graf
Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany
Patric Kröpil, Gerald Antoch, Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany
Wolfram Trudo Knoefel, Department of General Surgery, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany
Jasmin Riemer, Department of Pathology, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany
Author contributions: Schneitler S, Graf D, Kröpil P, Riemer J, Antoch G, Knoefel WT and Häussinger D designed the report; Schneitler S, Graf D and Kröpil P wrote the paper; Schneitler S collected the clinical data; all authors provided final approval of the version to be published.
Supported by University of Düsseldorf, Medical Faculty, Düsseldorf, Germany.
Ethics approval: This case report has been reviewed and approved by the Ethics Committee of the School of Medicine of the University of Düsseldorf, Düsseldorf, Germany.
Informed consent: The patients described in this case report provided informed written consent for publication of their data in regards to this study.
Conflict-of-interest: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dirk Graf, PhD, Senior Consultant, Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Medical Faculty Düsseldorf, Germany, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
Telephone: +49-211- 8108122 Fax: +49-211-8118132
Received: December 8, 2014
Peer-review started: December 9, 2014
First decision: January 8, 2015
Revised: February 7, 2015
Accepted: March 18, 2015
Article in press: March 19, 2015
Published online: May 28, 2015

Patients with metastasized carcinoma of the pancreas have a very poor prognosis, and long-term survival cannot be expected. This case report describes two patients with an initial diagnosis of metastatic pancreatic cancer, both with hepatic metastases and one with an additional peritoneal carcinomatosis. Initially, both patients were treated intravenously with the FOLFIRINOX chemotherapy regimen, consisting of 5-FU, folinic acid, irinotecan and oxaliplatin. Surprisingly, the FOLFIRINOX treatment resulted in complete resolution of the hepatic metastases in both patients, with no lesions detectable by computed tomography scan. Furthermore, treatment response included decreased diameter of the primary tumor in the tail of the pancreas and disappearance of the additional peritoneal carcinomatosis. Both patients were discussed by our multidisciplinary tumor board, which recommended surgical resections of the carcinoma. The R0 resection of the primary tumor was successful in both cases and, interestingly, the resected tissues showed no evidence of the hepatic metastases intraoperatively. In the first case, the patient received a postoperative 6-mo course of adjuvant chemotherapy with gemcitabine. In the second case, the patient continued to receive the FOLFIRINOX regimen for an additional 6 mo postoperatively. At 12 mo after the operation, a nonresectable retroperitoneal lymph node metastasis was detected in the first patient, whereas the second patient remained in complete remission at the time of this report (5 mo after the adjuvant therapy was discontinued). This case report is the first of its kind to describe two cases of hepatic metastatic pancreatic carcinoma that were resectable following treatment with FOLFIRINOX. Further studies are required to examine the role of FOLFIRINOX as a neoadjuvant treatment option in subgroups of patients with initially metastasized pancreatic carcinoma.

Keywords: FOLFIRINOX, Neoadjuvant treatment of pancreatic neoplasms, Chemotherapy, Metastatic pancreatic neoplasm, Curative operation

Core tip: The FOLFIRINOX regimen is a promising treatment option for metastatic pancreatic carcinoma. This case report describes two cases in which treating metastatic pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy prior to R0 resection was possible. The positive outcomes for these patients provide hope that metastatic pancreatic neoplasms may be cured in certain cases.