Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas Responsive to Combination Therapy with Gemcitabine and S-1

Yamamoto, Masahiro; Miyagawa, Koichiro; Hiura, Masaaki; Taguchi, Masashi; Kihara, Yasuyuki; Abe, Shintaro; Shimajiri, Shohei; Harada, Masaru

doi:10.2169/internalmedicine.51.6378

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…[ 10 – 12 ] However, several case reports also showed that S-1 was effective for patients with high-grade endocrine neoplasms of the pancreas. [ 13 – 17 ]…”

Section: Discussionmentioning

confidence: 99%

A case report of mixed acinar-endocrine carcinoma of the pancreas treated with S-1 chemotherapy

et al. 2017

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Rationale:Acinar cell carcinomas (ACCs) and mixed acinar-endocrine carcinomas (MAECs) of the pancreas are rare, accounting for only 1% of pancreatic tumors. Although both typically present at an advanced stage, chemotherapeutic regimes have not yet been standardized.Patient concerns:A 65-year-old man presented with a large mass in the pancreatic tail with multiple liver metastases.Diagnosis, Interventions, Outcomes:He was initially treated with gemcitabine for suspected ductal carcinoma of the pancreas, but no response was observed. S-1, administered as second-line chemotherapy, showed an approximately 38% reduction in the size of the primary tumor and metastatic deposits with therapeutic effects being maintained for 12 months. When the tumor progressed again, he underwent a percutaneous liver biopsy, which led to the diagnosis of MAEC. Combination therapy with cisplatin and etoposide targeting the endocrine component was administered, and this was based on the endocrine component potentially being less sensitive to S-1 than the ACC element. However, therapy was stopped due to the development of neutropenia, and the patient is currently receiving best supportive care.Lessons:Given the previous studies suggested that S-1 is more effective for ACCs than gemcitabine, MAECs may also respond to S-1 chemotherapy, similar to ACCs. Another potential interpretation is that S-1 was effective when the condition was ACC, and eventually showed decreased effectiveness when the condition shifted to MAEC. Future studies are needed to conclude whether S-1 chemotherapy truly works against MAECs or induces endocrine differentiation in ACCs as a part of the drug-resistance process.

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“…[ 10 – 12 ] However, several case reports also showed that S-1 was effective for patients with high-grade endocrine neoplasms of the pancreas. [ 13 – 17 ]…”

Section: Discussionmentioning

confidence: 99%

A case report of mixed acinar-endocrine carcinoma of the pancreas treated with S-1 chemotherapy

et al. 2017

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“…Hence, we decided to administer chemotherapy with S-1 and octreotide. To the best of our knowledge, several patients with pancreatic NETs who were treated with S-1 have been reported in the Japanese and English literature (Table 1) [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. S-1 was used as a single agent, as well as in combination therapy.…”

Section: Discussionmentioning

confidence: 99%

“…S-1 consists of a combination of drugs such as octreotide, gemcitabine, and streptozocin. The anti-growth effect of S-1 containing chemotherapy varies from partial response to progressive disease by case reports [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy of S-1 Chemotherapy plus Administration of Octreotide for a Patient with Metastatic Neuroendocrine Tumor (Gastrinoma)

2017

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Metastatic neuroendocrine tumors (gastrinomas) have a poor prognosis. Octreotide can reduce gastrin levels and alleviate hormonal symptoms, and possibly slow tumor growth as well. No drugs were available except streptozocin for the treatment of metastatic pancreatic neuroendocrine tumor (PNET) in 2008. We report a case of PNET in a 53-year-old woman with multiple liver tumors treated with S-1 plus octreotide. After 6 months from the initiation of the treatment, the pancreatic tumor and liver metastases regressed, and the patient achieved partial response without the development of any serious adverse event. For more than 8 years, the patient has remained asymptomatic without disease progression and is continuing treatment with octreotide and S-1. A marked suppression of gastrin levels has also been achieved. Combination therapy with octreotide and S-1 has been effective and well tolerated in patients with metastatic gastrinoma.

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“…On the other hand, for poorly-differentiated NECs of the pancreas, the NCCN guidelines and North American Neuroendocrine Tumor Society consensus guidelines (6) recommend combined chemotherapy with cisplatin and etoposide, one of the standard regimens employed for the treatment of small cell lung cancer. In addition, the efficacies of GEM and oral S-1 (7), bevacizumab (8), folinic acid, fluorouracil and irinotecan (9), valproic acid (10) and other treatments have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic body adenocarcinoma with neuroendocrine tumor characteristics: A case report

et al. 2014

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A 61-year-old female with pancreatic body cancer underwent a distal pancreatectomy. The tumor was a moderately- to poorly-differentiated adenocarcinoma. Tumor growth filled the dilated main pancreatic duct (MPD) and infiltrated the surrounding area. Six months later, metastases to the left diaphragm and MPD of the remnant pancreatic head were detected. Chemoradiotherapy was administered, but the patient succumbed 22 months after surgery. An autopsy demonstrated that a moderately- to poorly-differentiated adenocarcinoma had arisen from the pancreatic head and infiltrated the duodenum and bile duct. Huge liver metastases and multiple peritoneal disseminations were also present. Microscopically, a portion of the tumor had a pseudo-rosette appearance in the adenocarcinoma component, while another section showed characteristics of a neuroendocrine tumor (NET) immunohistochemically. The original surgically-resected tumor also showed NET characteristics immunohistochemically. It is therefore necessary to search for NET components in pancreatic cancer with atypical growth and metastases, even when adenocarcinoma has been diagnosed histologically.

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Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas Responsive to Combination Therapy with Gemcitabine and S-1

Cited by 7 publications

References 28 publications

A case report of mixed acinar-endocrine carcinoma of the pancreas treated with S-1 chemotherapy

A case report of mixed acinar-endocrine carcinoma of the pancreas treated with S-1 chemotherapy

Long-Term Efficacy of S-1 Chemotherapy plus Administration of Octreotide for a Patient with Metastatic Neuroendocrine Tumor (Gastrinoma)

Pancreatic body adenocarcinoma with neuroendocrine tumor characteristics: A case report

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