Kong XL, Lu XW, Dong SQ, Liu J, Zheng L, Chen LL, An ZH, Gao LM, Cao JL. Descending duodenal adenocarcinoma treated with pembrolizumab resulting in complete clinical response: A case report and literature review. World J Gastrointest Oncol 2025; 17(6): 107568 [DOI: 10.4251/wjgo.v17.i6.107568]
Corresponding Author of This Article
Jun-Li Cao, Department of Oncology, The First Hospital of Qinhuangdao, The Affiliated Qinhuangdao First Hospital of Hebei Medical University, No. 258 Wenhua Road, Qinhuangdao 066000, Hebei Province, China. kongxianglei@qhdsdyyy.com
Research Domain of This Article
Medical Ethics
Article-Type of This Article
Case Report
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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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107568 Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107568
Descending duodenal adenocarcinoma treated with pembrolizumab resulting in complete clinical response: A case report and literature review
Xiang-Lei Kong, Xi-Wei Lu, Si-Qi Dong, Jiao Liu, Lei Zheng, Lan-Lan Chen, Zi-Hui An, Li-Ming Gao, Jun-Li Cao
Xiang-Lei Kong, Xi-Wei Lu, Jiao Liu, Lei Zheng, Lan-Lan Chen, Li-Ming Gao, Department of Oncology, The First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
Si-Qi Dong, Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
Zi-Hui An, Jun-Li Cao, Department of Oncology, The First Hospital of Qinhuangdao, The Affiliated Qinhuangdao First Hospital of Hebei Medical University, Qinhuangdao 066000, Hebei Province, China
Author contributions: Kong XL, Chen LL and An ZH contributed to case collection and treatment; Kong XL, Lu XW and Liu J contributed to literature review and discussion; Kong XL, Dong SQ, Zheng L, Cao JL and Gao LM contributed to manuscript writing and revision; All authors have read and approved the final manuscript.
Supported by Medical Science Research Project of Hebei Province in 2023, Key Laboratory of Research on Molecular Mechanism of Gastrointestinal Tumors in Qinhuangdao, No. 20231891.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Li Cao, Department of Oncology, The First Hospital of Qinhuangdao, The Affiliated Qinhuangdao First Hospital of Hebei Medical University, No. 258 Wenhua Road, Qinhuangdao 066000, Hebei Province, China. kongxianglei@qhdsdyyy.com
Received: March 27, 2025 Revised: April 16, 2025 Accepted: May 21, 2025 Published online: June 15, 2025 Processing time: 78 Days and 23.1 Hours
Abstract
BACKGROUND
Descending duodenal adenocarcinoma (DDA) is a rare malignancy of the digestive system, typically characterized by microsatellite instability-high (MSI-H). Pembrolizumab is a monoclonal antibody that has been approved for the treatment of MSI-H solid tumors in China.
CASE SUMMARY
We present the case of a 55-year-old female patient diagnosed with DDA. Biopsy findings indicated MSI-H status with high expression of programmed cell death-ligand 1 (PD-L1). The patient was unable to undergo immediate surgery due to multiple metastatic lymph nodes in the retroperitoneum. After one cycle of the SOX (S-1 + oxaliplatin) chemotherapy regimen, the patient’s performance status significantly declined, and she experienced active gastrointestinal bleeding. Following active communication with the patient's family, pembrolizumab treatment was initiated. After two cycles of treatment, the disease was assessed as a partial response. A positron emission tomography/computed tomography scan performed after two years of treatment indicated a clinical complete response (CCR). The patient maintained this CCR for four years. She has now discontinued pembrolizumab for over one year, and no disease recurrence has been observed during re-examination.
CONCLUSION
Patients with MSI-H DDA exhibiting high PD-L1 expression who are treated with pembrolizumab can achieve sustained CCR.
Core Tip: Descending duodenal adenocarcinoma (DDA) is a rare malignancy of the digestive system. We treated a patient with DDA characterized by microsatellite instability-high (MSI-H) and high programmed cell death-ligand 1 expression, customizing the treatment regimen for individualized pembrolizumab therapy based on our clinical experience and disease assessment. The patient achieved long-term clinical remission with satisfactory results. This case underscores the advantages of individualized therapy and confirms that patients with mismatch-repair deficiency/MSI-H can derive significant benefits from pembrolizumab.
