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

Abstract

We report a case in which combination therapy with albumin-bound paclitaxel (nab-paclitaxel) and gemcitabine converted unresectable pancreatic cancer with peritoneal metastases into resectable disease. The patient was a 71-year-old woman with anorexia. Enhanced abdominal computed tomography (CT) showed an atrophic pancreatic body and tail, dilated main pancreatic duct, peritoneal dissemination, portal vein stricture, bile duct stricture and wall thickening, and blockage of the right ureter. She was diagnosed with pancreatic cancer with peritoneal metastases. Curative resection was initially impossible. Combination therapy consisting of nab-paclitaxel and gemcitabine was initiated. The regimen consisted of 28-day cycles of albumin-bound paclitaxel (nab-paclitaxel) (125 mg/m 2 intravenously over 30 min on days 1, 8, 15) and gemcitabine (1000 mg/ m 2 intravenously over 30 min on days 1, 8, 15). After 8 cycles of chemotherapy, enhanced CT showed no evidence of the tumor in the pancreatic body and tail or peritoneal metastases. Positron emission tomography with CT (PET-CT) showed no abnormal fluorodeoxyglucose uptake. After pre-operative chemotherapy for 8 months, the patient was underwent distal pancreatectomy with resection of soft tissue that corresponded to the right ureteral tumor seen on enhanced CT. This case showed that chemotherapy consisting of nab-paclitaxel and gemcitabine can be well-tolerated and can convert unresectable pancreatic cancer with peritoneal metastases into resectable disease.

Head-to-head comparison between FOLFIRINOX and gemcitabine plus nab-paclitaxel in the neoadjuvant chemotherapy of localized pancreatic cancer: a systematic review and meta-analysis

“…The results demonstrated that neoadjuvant FOLFIRINOX significantly improved overall survival over that with GA after adjusting for potential confounding factors. A lot of case reports also separately showed the successful conversion cases by neoadjuvant GA or FOLFIRINOX (34)(35)(36)(37)(38)(39)(40). For example, Gostimir et al presented a case whose lesion had decreased in size and complete pathological response after underwent treatment with a total of 13 cycles of FOLFIRINOX.…”