Conversion therapy for pancreatic cancer with peritoneal metastases using intravenous and intraperitoneal paclitaxel with S-1

Abstract

Abstract. Combination chemotherapy consisting of systemic and intraperitoneal agents against peritoneal metastases from several types of cancer has shown promising results. We herein report a case in which combination therapy with intravenous and intraperitoneal paclitaxel with S-1 converted an unresectable pancreatic cancer with peritoneal metastases into a resectable one. The patient was a 65-year old woman with recurrent pancreatitis for 5 months. Endoscopic ultrasonography-guided fine-needle aspiration revealed minute epithelial masses composed of cells with irregular nuclei in the pancreatic body. The patient underwent abdominal surgery, but no excision was performed, as two peritoneal metastases in the bursa omentalis were detected. Combination therapy was initiated, consisting of intravenous and intraperitoneal paclitaxel with S-1 as a single-center clinical trial. The regimen consisted with 2-week administration of S-1 (80 mg per day) followed by 1 week of rest, intravenous paclitaxel 50 mg/m 2 , and intraperitoneal paclitaxel 20 mg/m 2 by a peritoneal access device on days 1 and 8. Over the seven cycles of the chemotherapy, the primary lesion did not change in size, and peritoneal lavage cytology remained negative. After confirming the disappearance of the peritoneal lesions by exploratory laparoscopy, the patient underwent distal pancreatectomy combined with resection of the transverse mesocolon and stomach wall. Thus, the 2-way chemotherapy of intravenous and intraperitoneal paclitaxel with S-1 was well-tolerated and was able to convert pancreatic cancer with peritoneal metastases to resectable disease.

Successful conversion surgery for unresectable pancreatic cancer with peritoneal metastases after neoadjuvant albumin-bound paclitaxel and gemcitabine chemotherapy: case report and literature review

“…Some reports have documented unresectable pancreatic cancer being converted into resectable disease with chemotherapy and prolonged overall survival after surgery [6][7][8][9][10][11][12][13]. We found 12 patients who underwent conversion surgery after neoadjuvant chemotherapy for pancreatic cancer initially diagnosed as unresectable ( Table 1).…”

“…Since 1997, gemcitabine has been the standard first-line treatment for patients with unresectable locally advanced or metastatic pancreatic cancer [4], but the rate of complete or partial response with gemcitabine ranges from 7 to 9.4% [3,5]. Few patients have undergone conversion surgery after chemotherapy for unresectable pancreatic cancer [6][7][8][9][10][11][12][13]. However, 2 recent trials of systemic chemotherapy in metastatic pancreatic cancer have shown promise.…”

“…Eleven patients received FOLFIRINOX or gemcitabine-based chemotherapy. One patient with peritoneal metastasis received intravenous and intraperitoneal paclitaxel with S-1 [12]. Although the addition of nab-paclitaxel to gemcitabine is now widely accepted as one of the most effective chemotherapy regimens for unresectable pancreatic cancer [14], there have been no reports of patients successfully treated with surgery after chemotherapy that included nab-paclitaxel.…”

The Cell Line-Dependent Diversity in Initial Morphological Dynamics of Pancreatic Cancer Cell Peritoneal Metastasis Visualized by an Artificial Human Peritoneal Model

“…1,2 Currently, almost no effective therapy has been found to control or overcome this pathogenesis, 3,4 although intraperitoneal direct administration of anticancer drugs, such as paclitaxel, has been considered. 5 The postoperative occurrence of PM also has been associated with the therapeutic issue of surgery-induced shedding of cancer cells. 6 In some cases, presurgical endoscopic ultrasoundguided fine-needle biopsy can cause PM due to needle tract seeding.…”