FOLFIRINOX as First-Line Treatment for Unresectable Acinar Cell Carcinoma of the Pancreas: A Case Report

Abstract

Pancreatic acinar cell carcinoma (ACC) is a rare, aggressive variant of pancreatic ductal adenocarcinoma. Surgery is the only curative treatment option and protocols for palliative chemotherapies in this context are not standardized yet. We reported a 63-year-old white male patient who had painless jaundice, weight loss, elevated bilirubin, and a mass of the pancreatic head as well as liver metastasis. Core biopsy revealed the diagnosis of ACC. Therapy with FOLFIRINOX resulted in a significant decrease of the primary tumor and regressiveness of a liver metastasis after chemotherapy. Our report suggests that pancreatic ACC treated by FOLFIRINOX is well tolerated and might be superior to other single chemotherapies in this rare tumor disease.

Pancreatic acinar cell carcinoma with bilateral ovarian metastases, panniculitis and polyarthritis treated with FOLFIRINOX chemotherapy regimen. A case report and review of the literature

“…Partial responses with cytarabine and cisplatin combinations have been reported [5], as well as the case of a patient responding to fifth-line paclitaxel after progression to gemcitabine, capecitabine, combination of raltitrexed and oxaliplatin, and irinotecan [21]. Recently it was reported a case of a 63 year-old patient that achieved complete remission of liver metastases and a major response of the pancreatic mass with FOLFIRINOX [33]. Other treatment modalities such as chemoradiotherapy (using 5-fluorouracil or gemcitabine) in unresectable localized disease [6e9] and chemoembolization have shown clinical benefit in several reports [34].…”

Systematic Review and Case Series Report of Acinar Cell Carcinoma of the Pancreas

“…Use of folinic acid/fluorouracil/irinotecan/oxaliplatin (FOLFIRINOX) as first-line therapy for metastatic acinar cell carcinoma of the pancreas has been described in the literature, but whether the benefits of such an aggressive regimen outweighs the risks is unclear. 39 Because rates of disease control are higher with the use of combination, fluoropyrimidine-based chemotherapies, we also consider FOLFIRINOX in relatively young, very highly active individuals with ECOG performance status 0 (but rarely seen in our clinical practice). Among patients with moderate ECOG performance status 1 to 2, gemcitabine combined with protein-bound paclitaxel is our preferred chemotherapy regimen, with single-agent gemcitabine used for patients with poor performance status not wishing to enter hospice or palliative care.…”

A comparison study of pancreatic acinar cell carcinoma with ductal adenocarcinoma using computed tomography in Chinese patients

“… 19 In addition, several reports have described a good prognosis after intervention with therapeutic regimens, such as FOLFIRINOX and S1, which differ from the treatments used in DAC patients. 8 , 9 The malignant potential of ACC is significantly different from DAC. With proper regional, systemic, and targeted therapy, advanced ACC patients can survive >7 years after diagnosis.…”

“…There are only a few reports on the imaging performance, treatment, and outcome of ACC, and most of them are only case reports or small number series. 4 , 5 , 8 – 10 Many issues concerning this tumor remain unclear. 11 In particular, there is no consensus regarding the preoperative distinction of ACC from other pancreatic neoplasms.…”