An Effective Personalized Approach to a Rare Tumor: Prolonged Survival in Metastatic Pancreatic Acinar Cell Carcinoma Based on Genetic Analysis and Cell Line Development

Abstract

Acinar cell carcinoma of the pancreas is an uncommon malignancy, accounting for less than 1% of all pancreatic neoplasms. Because of its rarity, only a few retrospective studies are available to help guide management. We report the case of a patient with metastatic ACC who achieved prolonged survival as a result of personalized treatment designed in part on the basis of molecular and in-vitro data collected on analysis of the tumor and a cell line developed from the liver metastasis. To our knowledge, this represents the first human cell line of ACC. The molecular findings on this case and this patient's cell line may be of use in the management of future cases of this rare tumor and allow the identification of potential novel targets for the effective treatment of this disease.

Personalized Chemotherapy Profiling Using Cancer Cell Lines from Selectable Mice

“…This permits one to test all FDA approved anti-neoplastics, FDA approved drugs for other indications, late phase clinical trial drugs, herbal drugs and drugs approved in other countries for clinical use. The idea of screening drugs using cancer cell lines is well established (reviewed in (19)), and the personalized approach has recently been validated for one patient with a rare type of pancreatic cancer, acincar-cell carcinoma (20). …”

Multimodal approach and long-term survival in a patient with recurrent metastatic acinar cell carcinoma of the pancreas: A case report

“…combined with a survival over five years is demonstrated by Armstrong et al [20]. Sumiyoshi et al [21] describe a case with peritoneal dissemination and a recurrence-free survival over six years after distal pancreatectomy, partial gastrectomy and resection of disseminated nodules followed by oral S-1 chemotherapy (tegafur, gimeracil, oteracil potassium).…”

“…Armstrong et al [20] distal pancreatectomy, splenectomy, re-resection of the margin and hepatic radiofrequency ablation (RFA) adjuvant therapy with gemcitabine and cisplatin followed by radiation to the pancreatic bed accompanied by cisplatin cycles 2) resection of liver/peritoneal metastases, extensive lymphadenectomy; oxaliplatin [hypersensitivity reaction] later carboplatin, gemcitabine, cetuximab and bevacizumab 3) repeated hepatic RFA; carboplatin (later stopped), gemcitabine, cetuximab and bevacizumab [proteinuria] 4) repeat para-aortic lymphadenectomy, intraoperative hepatic RFA 5) gemcitabine, capecitabine, cetuximab 6) right/left partial adrenalectomy, partial peritonectomy, extensive lymphadenectomy 7) liposomal doxorubicin followed by nab-paclitaxel with panitumumab 8) resection of a retroperitoneal mass and completion of left adrenalectomy 9) left frontal brain metastasis resection 10) nab-paclitaxel and panitumumab over eleven years since diagnosis Abbreviations: 5-FU: 5-fluorouracil; FOLFIRI: folinic acid, 5-FU, irinotecan; FOLFOX: folinic acid, 5-FU, oxaliplatin; [side effects causal for termination]. combined with a survival over five years is demonstrated by Armstrong et al [20].…”

The molecular and cellular heterogeneity of pancreatic ductal adenocarcinoma

“…A case report of successful treatment of a patient with pancreatic acinar cell carcinoma, which accounts for <1% of pancreatic cancers, was based on genomic profiling of the patient's tumor and further in vitro analysis using a cell line derived from the patient's liver metastasis biopsy sample. 90 In this study, genetic alterations in genes that are potential targets for drugs were targeted in vitro in the patient's own tumor cell line and treatment of the patient was tailored on the basis of responses to those therapies in the cell culture. Unlike the majority of patients who present with pancreatic acinar cell carcinoma, the pro longed survival of the patient in this study was partly the result of therapy selection on the basis of the patient's individual tumor profile, rather than empiric systemic therapy.…”