Durable effect of imatinib and metronomic chemotherapy with capecitabine in pancreatic carcinoma

Abstract

Background: Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery (median survival: <30 months). The prognosis of borderline resectable pancreatic cancer (BR-PDC) is even worse. We describe a patient with BR-PDC who achieved stable disease with metronomic chemotherapy after refusing surgery.Case presentation: A 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, Fine needle aspiration (FNA) confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy. After the second cycle of mFOLFIRINOX -complicated by febrile neutropenia -she refused further IV therapy. Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis. The patient did well and she is currently alive with a stable disease as of 2 years after diagnosis. Conclusion:Metronomic chemotherapy, especially capecitabine added to the targeted therapy, imatinib, is a potentially useful treatment for PDC where no other options are available, especially those harbouring no mutation in the dominant four genes. Indeed, the absence of mutation with KIT amplification could be a potential marker for improved outcomes with targeted and metronomic therapy, which deserves further evaluation in a clinical trial setting.

Efficacy and Safety of Metronomic Capecitabine in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…Quality evaluation was performed in our meta-analysis using the Cochran's risk of bias assessment and it was found that the evaluation of scores in RCT showed a good value but, some unclear risk of selection bias was found in one of the studies 18 . All the single-arm studies showed scored good scores (between [11][12][13][14][15][16][17][18][19].…”

“…The evaluation of scores in RCT showed a good value in Cochran's risk of bias assessment, but, some unclear risk of selection bias was found in the study done by Zeng et al 18 . Figure 2 All the single-arm studies scored good scores (between [11][12][13][14][15][16][17][18][19] which suggests good quality studies (Table 1). The mean age of the patients was reported in two studies and they were found to be 66.7 ± 10.0 in the study done by Filippo et.…”

“…Several studies have been performed involving the use of metronomic capecitabine on metastatic breast cancer 16 , pancreatic cancer 17 , and various other cancers. The integration of metronomic capecitabine with this drug regimen has demonstrated enhanced overall survival and effectiveness among patients.…”