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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report
Alberto Meyer, Bárbara J Carvalho, Kayo AA Medeiros, Leonardo Z Pipek, Fernanda S Nascimento, Milena O Suzuki, João VT Munhoz, Leandro R Iuamoto, Luiz A Carneiro-D'Alburquerque, Wellington Andraus
Alberto Meyer, Luiz A Carneiro-D'Alburquerque, Wellington Andraus, Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01426-010, Brazil
Bárbara J Carvalho, Kayo AA Medeiros, Leonardo Z Pipek, Fernanda S Nascimento, Milena O Suzuki, João VT Munhoz, Gastroenterologia, Faculdade de Medicina, da Universidade de São Paulo, São Paulo 05403-000, Brazil
Leandro R Iuamoto, Orthopaedics and Traumatology, Faculdade de Medicina, da Universidade de São Paulo, São Paulo 05403-000, Brazil
Author contributions: Meyer A, Carvalho BJ and Medeiros KAA were responsible for study design and writing; Pipek LZ, Nascimento FS, Suzuki MO and Munhoz JVT were responsible for data collections and data analysis; Meyer A, Carneiro-D'Alburquerque LA and Andraus W were involved in the study design and were responsible for scientific revision; All authors read and approved the final manuscript.
Informed consent statement: Written consent was obtained from each patient authorizing to publish their individual data or any accompanied figures in this manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the 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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Alberto Meyer, FACS, MD, MSc, PhD, Assistant Professor, Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 455, São Paulo 01426-010, Brazil. alberto.meyer@usp.br
Received: December 2, 2020
Peer-review started: December 2, 2020
First decision: December 31, 2020
Revised: December 31, 2020
Accepted: February 23, 2021
Article in press: February 23, 2021
Published online: May 16, 2021
BACKGROUND
Neoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease. The aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line treatment.
CASE SUMMARY
Computerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas, measuring approximately 4.2 cm × 2.7 cm, with an infiltrative aspect. The tumor had contact with the superior mesenteric vein, splenomesenteric junction and the proximal segment of the splenic artery, causing focal reduction of its lumens. Due to vascular involvement, neoadjuvant chemotherapy treatment with eight cycles of “folinic acid, 5-fluorouracil, irinotecan and oxaliplatine” (FOLFIRINOX) were performed. At the end of the cycles, surgery was performed, but the procedure was interrupted due to finding of lesions suspected of metastasis. Gemcitabine plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical resection.
CONCLUSION
Gemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment, suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.
Core Tip: Neoadjuvant treatment with folinic acid, 5-fluorouracil, irinotecan and oxaliplatine or gemcitabine plus nab-paclitaxel has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease.
