Onkologie. 2023:17(2):101-107 | DOI: 10.36290/xon.2023.021

Metastatic pancreatic cancer and personalized therapy: a case report

Marián Liberko1, 2, Renata Soumarová1, 2
1 Onkologická klinika, 3. LF UK a FNKV, Praha
2 3. lékařská fakulta Univerzity Karlovy, Praha

We present a case report of a patient with pancreatic cancer who developed metastatic disease early after surgery and adjuvant therapy. Palliative systemic treatment resulted in long-term control of the disease, followed by pulmonary metastasectomy of residual lesions. Early relapse of the disease after metastasectomy was treated with platinum derivatives, based on the results of NGS testing. Personalized treatment has led to a rapid response and stabilization of the disease. Maintenance therapy with PARP inhibitors will follow in the future.

Keywords: pancreatic cancer, pulmonary metastasectomy, NGS, personalized therapy.

Accepted: April 26, 2023; Published: April 27, 2023  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Liberko M, Soumarová R. Metastatic pancreatic cancer and personalized therapy: a case report. Onkologie. 2023;17(2):101-107. doi: 10.36290/xon.2023.021.
Download citation

References

  1. Ústav zdravotnických informací a statistiky ČR: Národní onkologický registr (NOR) [20. 1. 2021]. Available from: http://www.uzis.cz/registry-nzis/nor.
  2. Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26 Suppl 5: v56-68. PMID: 26314780. DOI: 10.1093/annonc/mdv295. Go to original source... Go to PubMed...
  3. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297(3):267-77. doi: 10.1001/jama.297.3.267. PMID: 17227978. Go to original source... Go to PubMed...
  4. Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389(10073):1011-1024. PMID: 28129987. doi: 10.1016/S0140-6736(16)32409-6. Go to original source... Go to PubMed...
  5. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N Engl J Med. 2018; 379(25): 2395-2406. PMID: 30575490. doi: 10.1056/NEJMoa1809775. Go to original source... Go to PubMed...
  6. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15(6):2403-2413. doi: 10.1200/JCO.1997.15.6.2403. PMID: 9196156. Go to original source... Go to PubMed...
  7. Von Hoff DD, Ervin T, Arena FP. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691-1703. PMID: 24131140. doi: 10.1056/NEJMoa1304369. Go to original source... Go to PubMed...
  8. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817-1825. PMID: 21561347. doi: 10.1056/NEJMoa1011923. Go to original source... Go to PubMed...
  9. Wang-Gillam A, Li CP, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet. 2016;387(10018):545-557. PMID: 26615328. doi: 10.1016/S0140-6736(15)00986-1. Go to original source... Go to PubMed...
  10. Golan T, Hammel P, Reni M, et al. Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer. N Engl J Med. 2019;381(4):317-327. doi: 10.1056/NEJMoa1903387. Epub 2019 Jun 2. PMID: 31157963; PMCID: PMC6810605. Go to original source... Go to PubMed...
  11. Kindler HL, Hammel P, Reni M, et al. Overall Survival Results From the POLO Trial: A Phase III Study of Active Maintenance Olaparib Versus Placebo for Germline BRCA-Mutated Metastatic Pancreatic Cancer. J Clin Oncol. 2022;40(34):3929-3939. doi: 10.1200/JCO.21.01604. Epub 2022 Jul 14. PMID: 35834777. Go to original source... Go to PubMed...
  12. Conroy T, Castan F, Lopez A, et al. Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial. JAMA Oncol. 2022;8(11):1571-1578. doi: 10.1001/jamaoncol.2022.3829. Erratum in: JAMA Oncol. 2023 Jan 1;9(1):151. PMID: 36048453; PMCID: PMC9437831. Go to original source... Go to PubMed...
  13. Abrams RA, Winter KA, Safran H, et al. Results of the NRG Oncology/RTOG 0848 Adjuvant Chemotherapy Question-Erlotinib+Gemcitabine for Resected Cancer of the Pancreatic Head: A Phase II Randomized Clinical Trial. Am J Clin Oncol. 2020;43(3):173-179. doi: 10.1097/COC.0000000000000633. PMID: 31985516; PMCID: PMC7280743. Go to original source... Go to PubMed...
  14. Ren F, Xu YC, Wang HX, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, for resectable advanced pancreatic adenocarcinoma: continue or stop? Pancreatology. 2012;12(2):162-169. doi: 10.1016/j.pan.2012.02.002. Epub 2012 Feb 8. PMID: 22487527. Go to original source... Go to PubMed...
  15. Liao WC, Chien KL, Lin YL, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14(11):1095-1103. doi: 10.1016/S1470-2045(13)70388-7. Epub 2013 Sep 12. PMID: 24035532. Go to original source... Go to PubMed...
  16. Luo Y. The role of radiotherapy for pancreatic malignancies: a population-based analysis of the SEER database. Clin Transl Oncol. 2022;24(1):76-83. doi: 10.1007/s12094-021-02671-0. Epub 2021 Jul 4. Erratum in: Clin Transl Oncol. 2021 Aug 24;: PMID: 34219204; PMCID: PMC8732853. Go to original source... Go to PubMed...
  17. Chen LT, Siveke JT, Wang-Gillam A, et al. Survival with nal-IRI (liposomal irinotecan) plus 5-fluorouracil and leucovorin versus 5-fluorouracil and leucovorin in per-protocol and non-per-protocol populations of NAPOLI-1: Expanded analysis of a global phase 3 trial. Eur J Cancer. 2018;105:71-78. doi: 10.1016/j.ejca.2018.09.010. Epub 2018 Nov 8. PMID: 30414528. Go to original source... Go to PubMed...
  18. Wang-Gillam A, Hubner RA, Siveke JT, et al. NAPOLI-1 phase 3 study of liposomal irinotecan in metastatic pancreatic cancer: Final overall survival analysis and characteristics of long-term survivors. Eur J Cancer. 2019;108:78-87. doi: 10.1016/j.ejca.2018.12.007. Epub 2019 Jan 14. PMID: 30654298. Go to original source... Go to PubMed...
  19. Macarulla Mercadé T, Chen LT, Li CP, et al. Liposomal Irinotecan + 5-FU/LV in Metastatic Pancreatic Cancer: Subgroup Analyses of Patient, Tumor, and Previous Treatment Characteristics in the Pivotal NAPOLI-1 Trial. Pancreas. 2020;49(1):62-75. doi: 10.1097/MPA.0000000000001455. Erratum in: Pancreas. 2020 Mar;49(3):e27. PMID: 31856081; PMCID: PMC6946097. Go to original source... Go to PubMed...
  20. Ilmer M, Schiergens TS, Renz BW, et al. Oligometastatic pulmonary metastasis in pancreatic cancer patients: Safety and outcome of resection. Surg Oncol. 2019;31:16-21. doi: 10.1016/j.suronc.2019.08.010. Epub 2019 Aug 26. PMID: 31473583. Go to original source... Go to PubMed...
  21. Mashiko T, Nakano A, Masuoka Y, et al. Significance of pulmonary resection in patients with metachronous pulmonary metastasis from pancreatic ductal adenocarcinoma: a retrospective cohort study. BMC Surg. 2021;21(1):237. doi: 10.1186/s12893-021-01236-w. PMID: 33952223; PMCID: PMC8097936. Go to original source... Go to PubMed...
  22. Pishvaian MJ, Blais EM, Brody JR, et al. Outcomes in Patients With Pancreatic Adenocarcinoma With Genetic Mutations in DNA Damage Response Pathways: Results From the Know Your Tumor Program. JCO Precis Oncol. 2019;3:1-10. doi: 10.1200/PO.19.00115. PMID: 35100730. Go to original source... Go to PubMed...
  23. Park W, Chen J, Chou JF, et al. Genomic Methods Identify Homologous Recombination Deficiency in Pancreas Adenocarcinoma and Optimize Treatment Selection. Clin Cancer Res. 2020;26(13):3239-3247. doi: 10.1158/1078-0432.CCR-20-0418. Epub 2020 May 22. PMID: 32444418; PMCID: PMC7380542. Go to original source... Go to PubMed...
  24. Wattenberg MM, Asch D, Yu S, et al. Platinum response characteristics of patients with pancreatic ductal adenocarcinoma and a germline BRCA1, BRCA2 or PALB2 mutation. Br J Cancer. 2020;122(3):333-339. doi: 10.1038/s41416-019-0582-7. Epub 2019 Dec 2. PMID: 31787751; PMCID: PMC7000723. Go to original source... Go to PubMed...
  25. Yu S, Agarwal P, Mamtani R, et al. Retrospective Survival Analysis of Patients With Resected Pancreatic Ductal Adenocarcinoma and a Germline BRCA or PALB2 Mutation. JCO Precis Oncol. 2019;3:1-11. doi: 10.1200/PO.18.00271. PMID: 35100679. Go to original source... Go to PubMed...
  26. Shroff RT, Hendifar A, McWilliams RR, et al. Rucaparib Monotherapy in Patients With Pancreatic Cancer and a Known Deleterious BRCA Mutation. JCO Precis Oncol. 2018;2018:PO.17.00316. doi: 10.1200/PO.17.00316. Epub 2018 May 16. PMID: 30051098; PMCID: PMC6057747. Go to original source... Go to PubMed...
  27. Reiss KA, Mick R, O'Hara MH, et al. Phase II Study of Maintenance Rucaparib in Patients With Platinum-Sensitive Advanced Pancreatic Cancer and a Pathogenic Germline or Somatic Variant in BRCA1, BRCA2, or PALB2. J Clin Oncol. 2021;39(22):2497-2505. doi: 10.1200/JCO.21.00003. Epub 2021 May 10. PMID: 33970687. Go to original source... Go to PubMed...




Oncology

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.