Searching for novel multimodal treatments in oligometastatic pancreatic cancer

Abstract

Background: Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. Case presentation: We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/ mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. Conclusions: Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

Highly Selective Targeting of Pancreatic Cancer in the Liver with a Near-Infrared Anti-MUC5AC Probe in a PDOX Mouse Model: A Proof-of-Concept Study

“…In nearly all of these cases, the procedure will be aborted. In carefully selected patients, a survival benefit has been shown with the resection of hepatic oligometastatic disease in PDAC [ 31 , 32 , 33 , 34 ]. A phase 2 clinical trial is currently underway comparing neoadjuvant therapy and the resection of hepatic oligometastatic pancreatic cancer to historical data [ 35 ].…”

Defining oligometastatic pancreatic cancer: a systematic review and critical synthesis of consensus

“…Novel multimodal preoperative therapy in pancreatic cancer have led to an increased number of case reports and retrospective series that in highly selected pancreatic cancer patients’ LCT of metastases might result in favorable outcomes as well. 44 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 In particular, complete response to chemotherapy based on imaging criteria has encouraged clinicians to seek resection of metastases in addition to the primary tumor as part of individualized treatment strategies. 44 , 115 , 116 …”

Current status of pancreatic cancer with oligometastasis

“…Pancreatic ductal adenocarcinoma (PDA) accounts for over 85% of all pancreatic malignancies 1,2 . The 5-year survival rate is nearly 2% to 10% [3][4][5][6][7][8] , with a median overall survival of < 12 months, depending on the stage 9 . It is estimated that, at the time of diagnosis, up to 50% 6,7 of the patients already have metastases 6,7 , being the liver the most common location, followed by the lung 10 .…”