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BMC Cancer
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Case report

Complete pathological response following neoadjuvant FOLFIRINOX in borderline resectable pancreatic cancer - a case report and review

Authors: Mišo Gostimir, Sean Bennett, Terence Moyana, Harman Sekhon, Guillaume Martel

Published in: BMC Cancer | Issue 1/2016

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Abstract

Background

Pancreatic cancer is among the top 5 most common cancers worldwide, but is particularly devastating due to its insidious nature. Complete surgical resection remains the only potential curative treatment, although only 20 % of patients present with a resectable tumor. Patients may alternatively present with borderline resectable pancreatic cancer or locally advanced pancreatic cancer and can be offered treatment with neoadjuvant intent. The effectiveness of these treatments is unclear and there is a paucity of data to suggest one optimal treatment approach.

Case presentation

We describe a 61-year-old female who presented with a two-week history of obstructive jaundice in the context of vague abdominal pain that had been ongoing for years prior to her visit. CT scan of the abdomen confirmed a hypovascular mass in the uncinate process consistent with borderline resectable pancreatic cancer. Pancreatic adenocarcinoma was confirmed with endoscopic ultrasound guided fine-needle aspiration cytology. Following multidisciplinary discussion, it was recommended that she undergo treatment with FOLFIRINOX. After a total of 13 cycles, follow up CT revealed that the lesion had decreased in size and she was offered resection as a potentially curative treatment. She underwent pancreaticoduodenectomy. Final pathology report revealed no evidence of residual adenocarcinoma (ypT0 ypN0 (0/23)). The patient remains disease-free 15 months following surgery.

Conclusion

To date, there have been very few reports of a complete pathological response following neoadjuvant therapy in borderline resectable or locally advanced pancreatic cancer. This report describes a unique case of a complete pathological remission in a patient with borderline resectable pancreatic cancer following FOLFIRINOX therapy alone and adds to the growing base of evidence meriting the initiation of clinical trials to assess the efficacy of FOLFIRINOX in these subsets of pancreatic cancer.
Literature
1.
Bond-Smith G, Banga N, Hammond TM, Imber CJ. Pancreatic adenocarcinoma. BMJ (Clinical research ed). 2012;344:e2476.
2.
3.
Rhim AD, Mirek ET, Aiello NM, Maitra A, Bailey JM, McAllister F, Reichert M, Beatty GL, Rustgi AK, Vonderheide RH, et al. Emt and dissemination precede pancreatic tumor formation. Cell. 2012;148:349–61.CrossRefPubMedPubMedCentral
4.
Haeno H, Gonen M, Davis MB, Herman JM, Iacobuzio-Donahue CA, Michor F. Computational modeling of pancreatic cancer reveals kinetics of metastasis suggesting optimum treatment strategies. Cell. 2012;148:362–75.CrossRefPubMedPubMedCentral
5.
Hartlapp I, Muller J, Kenn W, Steger U, Isbert C, Scheurlen M, Germer CT, Einsele H, Kunzmann V. Complete pathological remission of locally advanced, unresectable pancreatic cancer (lapc) after intensified neoadjuvant chemotherapy. Onkologie. 2013;36:123–5.CrossRefPubMed
6.
Elias A, Chatzizacharias NA, Xanthis A, Corrie P, Davies S, Brais RJ, Jamieson NV, Praseedom RK, Huguet E, Harper SJ, et al. Salvage pancreaticoduodenectomy after complete response to chemoradiotherapy for a previously unresectable pancreatic adenosquamous carcinoma: a case report. Medicine. 2015;94:e499.CrossRefPubMedPubMedCentral
7.
Cascinu S, Falconi M, Valentini V, Jelic S. Pancreatic cancer: Esmo clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v55–8.CrossRefPubMed
8.
Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.CrossRefPubMed
9.
Tempero MA, Malafa MP, Behrman SW, 3rd Benson AB, Casper ES, Chiorean EG, Chung V, Cohen SJ, Czito B, Engebretson A, et al. Pancreatic adenocarcinoma, version 2.2014: Featured updates to the nccn guidelines. J Natl Compr Canc Netw. 2014;12:1083–93.PubMed
10.
11.
Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.CrossRefPubMed
12.
Lorenzen S, Thuss-Patience P, Al-Batran SE, Lordick F, Haller B, Schuster T, Pauligk C, Luley K, Bichev D, Schumacher G, et al. Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy. Ann Oncol. 2013;24:2068–73.CrossRefPubMed
13.
Zhao Q, Rashid A, Gong Y, Katz MH, Lee JE, Wolf R, Balachandran A, Varadhachary GR, Pisters PW, Wang H, et al. Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with a better prognosis. Ann Diagn Pathol. 2012;16:29–37.CrossRefPubMed
14.
Boone BA, Steve J, Krasinskas AM, Zureikat AH, Lembersky BC, Gibson MK, Stoller RG, Zeh HJ, Bahary N. Outcomes with folfirinox for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol. 2013;108:236–41.CrossRefPubMed
15.
Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, et al. Radiological and surgical implications of neoadjuvant treatment with folfirinox for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261:12–7.CrossRefPubMedPubMedCentral
16.
Mellon EA, Hoffe SE, Springett GM, Frakes JM, Strom TJ, Hodul PJ, Malafa MP, Chuong MD, Shridhar R. Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta oncologica (Stockholm, Sweden). 2015;54:979–85.CrossRef
17.
Moorcraft SY, Khan K, Peckitt C, Watkins D, Rao S, Cunningham D, Chau I. Folfirinox for locally advanced or metastatic pancreatic ductal adenocarcinoma: the royal marsden experience. Clin Colorectal Cancer. 2014;13:232–8.CrossRefPubMed
18.
Nitsche U, Wenzel P, Siveke JT, Braren R, Holzapfel K, Schlitter AM, Stoss C, Kong B, Esposito I, Erkan M, et al. Resectability after first-line folfirinox in initially unresectable locally advanced pancreatic cancer: a single-center experience. Ann Surg Oncol. 2015;22 Suppl 3:1212–20.CrossRef
19.
Paniccia A, Edil BH, Schulick RD, Byers JT, Meguid C, Gajdos C, McCarter MD. Neoadjuvant folfirinox application in borderline resectable pancreatic adenocarcinoma: a retrospective cohort study. Medicine. 2014;93:e198.CrossRefPubMedPubMedCentral
20.
Pietrasz D, Marthey L, Wagner M, Blanc JF, Laurent C, Turrini O, Raoul JL, Terrebonne E, Hentic O, Trouilloud I, et al. Pathologic major response after folfirinox is prognostic for patients secondary resected for borderline or locally advanced pancreatic adenocarcinoma: an ageo-french, prospective, multicentric cohort. Ann Surg Oncol. 2015;22 Suppl 3:1196–205.CrossRef
21.
Valeri S, Borzomati D, Nappo G, Perrone G, Santini D, Coppola R. Complete pathological response after folfirinox for locally advanced pancreatic cancer. the beginning of a new era? Case report and review of the literature. Pancreatology. 2014;14:425–30.CrossRefPubMed
22.
Washington MK, Berlin J, Branton PA, Burgart LJ, Carter DK, Compton CC, Fitzgibbons PL, Frankel WL, Jessup JM, Kakar S, et al. Protocol for the examination of specimens from patients with carcinoma of the distal extrahepatic bile ducts. Arch Pathol Lab Med. 2010;134:e8–e13.PubMed
23.
Gillen S, Schuster T, Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.CrossRefPubMedPubMedCentral
24.
Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, Wang H, Abbruzzese J, Pisters PW, Vauthey JN, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012;118:5749–56.CrossRefPubMed
25.
Seufferlein T, Bachet JB, Van Cutsem E, Rougier P. Pancreatic adenocarcinoma: esmo-esdo clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23 Suppl 7:vii33–40.CrossRefPubMed
26.
Heinemann V, Haas M, Boeck S. Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer. Ann Oncol. 2013;24:2484–92.CrossRefPubMed
27.
Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, Rich TA, Adams RB, Bauer TW. Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol. 2011;18:619–27.CrossRefPubMed
28.
Chun YS, Milestone BN, Watson JC, Cohen SJ, Burtness B, Engstrom PF, Haluszka O, Tokar JL, Hall MJ, Denlinger CS, et al. Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol. 2010;17:2832–8.CrossRefPubMed
29.
Leone F, Gatti M, Massucco P, Colombi F, Sperti E, Campanella D, Regge D, Gabriele P, Capussotti L, Aglietta M. Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer: a single institutional experience. Cancer. 2013;119:277–84.CrossRefPubMed
30.
Kim EJ, Ben-Josef E, Herman JM, Bekaii-Saab T, Dawson LA, Griffith KA, Francis IR, Greenson JK, Simeone DM, Lawrence TS, et al. A multi-institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. Cancer. 2013;119:2692–700.CrossRefPubMedPubMedCentral
31.
Takahashi H, Ohigashi H, Gotoh K, Marubashi S, Yamada T, Murata M, Ioka T, Uehara H, Yano M, Ishikawa O. Preoperative gemcitabine-based chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Ann Surg. 2013;258:1040–50.CrossRefPubMed
32.
Kang CM, Chung YE, Park JY, Sung JS, Hwang HK, Choi HJ, Kim H, Song SY, Lee WJ. Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg. 2012;16:509–17.CrossRefPubMed
33.
Chuong MD, Hayman TJ, Patel MR, Russell MS, Malafa MP, Hodul PJ, Springett GM, Choi J, Shridhar R, Hoffe SE. Comparison of 1-, 2-, and 3-dimensional tumor response assessment after neoadjuvant gtx-rt in borderline-resectable pancreatic cancer. Gastrointest Cancer Res. 2011;4:128–34.PubMedPubMedCentral
34.
Conroy T, Paillot B, Francois E, Bugat R, Jacob JH, Stein U, Nasca S, Metges JP, Rixe O, Michel P, et al. Irinotecan plus oxaliplatin and leucovorin-modulated fluorouracil in advanced pancreatic cancer--a groupe tumeurs digestives of the federation nationale des centres de lutte contre le cancer study. J Clin Oncol. 2005;23:1228–36.CrossRefPubMed
35.
Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardiere C, et al. Folfirinox versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.CrossRefPubMed
36.
Christians KK, Tsai S, Mahmoud A, Ritch P, Thomas JP, Wiebe L, Kelly T, Erickson B, Wang H, Evans DB, et al. Neoadjuvant folfirinox for borderline resectable pancreas cancer: a new treatment paradigm? Oncologist. 2014;19:266–74.CrossRefPubMedPubMedCentral
37.
Blazer M, Wu C, Goldberg RM, Phillips G, Schmidt C, Muscarella P, Wuthrick E, Williams TM, Reardon J, Ellison EC, et al. Neoadjuvant modified (m) folfirinox for locally advanced unresectable (lapc) and borderline resectable (brpc) adenocarcinoma of the pancreas. Ann Surg Oncol. 2015;22:1153–9.CrossRefPubMed
38.
Barugola G, Partelli S, Crippa S, Capelli P, D'Onofrio M, Pederzoli P, Falconi M. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg. 2012;203:132–9.CrossRefPubMed
39.
Khan AZ, Pitsinis V, Mudan SS. Complete pathological response following down-staging chemoradiation in locally advanced pancreatic cancer: challenging the boundaries. World J Gastroenterol. 2007;13:6433–5.CrossRefPubMedPubMedCentral
40.
Galindo J, Gabrielli M, Guerra JF, Cassina JC, Garrido M, Jarufe N, Borghero Y, Madrid J, Zoroquiain P, Roa JC, et al. Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases. World J Surg Oncol. 2013;11:37.CrossRefPubMedPubMedCentral
41.
Magnin V, Moutardier V, Giovannini MH, Lelong B, Giovannini M, Viret F, Monges G, Bardou VJ, Alzieu C, Delpero JR. Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer. Int J Radiat Oncol Biol Phys. 2003;55:1300–4.CrossRefPubMed
42.
Magnin V, Viret F, Moutardier V, Lelong B, Giovannini M, Monges G, Delpero JR. Complete pathologic responses to preoperative chemoradiation in two patients with adenocarcinoma of the pancreas. Pancreas. 2004;28:103–4.CrossRefPubMed
43.
Moutardier V, Magnin V, Turrini O, Viret F, Hennekinne-Mucci S, Goncalves A, Pesenti C, Guiramand J, Lelong B, Giovannini M, et al. Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2004;60:437–43.CrossRefPubMed
44.
Polistina F, Costantin G, Casamassima F, Francescon P, Guglielmi R, Panizzoni G, Febbraro A, Ambrosino G. Unresectable locally advanced pancreatic cancer: A multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Ann Surg Oncol. 2010;17:2092–101.CrossRefPubMed
45.
Rajagopalan MS, Heron DE, Wegner RE, Zeh HJ, Bahary N, Krasinskas AM, Lembersky B, Brand R, Moser AJ, Quinn AE, et al. Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiat. 2013;8:254.
46.
Reni M, Cereda S, Balzano G, Passoni P, Rognone A, Zerbi A, Nicoletti R, Mazza E, Arcidiacono PG, Di Carlo V, et al. Outcome of upfront combination chemotherapy followed by chemoradiation for locally advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol. 2009;64:1253–9.CrossRefPubMed
47.
White RR, Hurwitz HI, Morse MA, Lee C, Anscher MS, Paulson EK, Gottfried MR, Baillie J, Branch MS, Jowell PS, et al. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol. 2001;8:758–65.CrossRefPubMed
48.
White RR, Xie HB, Gottfried MR, Czito BG, Hurwitz HI, Morse MA, Blobe GC, Paulson EK, Baillie J, Branch MS, et al. Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol. 2005;12:214–21.CrossRefPubMed
49.
Wilkowski R, Thoma M, Bruns C, Wagner A, Heinemann V. Chemoradiotherapy with gemcitabine and continuous 5-fu in patients with primary inoperable pancreatic cancer. Jop. 2006;7:349–60.PubMed
50.
Ghorani E, Wong HH, Hewitt C, Calder J, Corrie P, Basu B. Safety and efficacy of modified folfirinox for advanced pancreatic adenocarcinoma: a uk single-centre experience. Oncology. 2015;89:281–7.CrossRefPubMed
51.
Mahaseth H, Brutcher E, Kauh J, Hawk N, Kim S, Chen Z, Kooby DA, Maithel SK, Landry J, El-Rayes BF. Modified folfirinox regimen with improved safety and maintained efficacy in pancreatic adenocarcinoma. Pancreas. 2013;42:1311–5.CrossRefPubMed
52.
Turner K, Levi Sandri GB, Boucher E, Henno S, Le Prise E, Meunier B, Boudjema K, Sulpice L. Complete radiological response of an initially locally advanced unresectable pancreatic cancer to chemoradiotherapy using folfirinox regimen: report of a case. Clin Res Hepatol Gastroenterol. 2015;39:e29–31.CrossRefPubMed
53.
Cooper AB, Tzeng CW, Katz MH: Treatment of borderline resectable pancreatic cancer. CurrTreat Opt Oncol. 14:293–310.
54.
Gunturu KS, Yao X, Cong X, Thumar JR, Hochster HS, Stein SM, Lacy J. Folfirinox for locally advanced and metastatic pancreatic cancer: single institution retrospective review of efficacy and toxicity. Medical oncology (Northwood, London, England). 2013;30:361.CrossRef
55.
Hosein PJ, Macintyre J, Kawamura C, Maldonado JC, Ernani V, Loaiza-Bonilla A, Narayanan G, Ribeiro A, Portelance L, Merchan JR, et al. A retrospective study of neoadjuvant folfirinox in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer. 2012;12:199.CrossRefPubMedPubMedCentral
56.
Khushman M, Dempsey N, Maldonado JC, Loaiza-Bonilla A, Velez M, Carcas L, Dammrich D, Hurtado-Cordovi J, Parajuli R, Pollack T, et al. Full dose neoadjuvant folfirinox is associated with prolonged survival in patients with locally advanced pancreatic adenocarcinoma. Pancreatology. 2015;15:667–73.CrossRefPubMed
57.
Peddi PF, Lubner S, McWilliams R, Tan BR, Picus J, Sorscher SM, Suresh R, Lockhart AC, Wang J, Menias C, et al. Multi-institutional experience with folfirinox in pancreatic adenocarcinoma. Jop. 2013;13:497–501.
Metadata
Title
Complete pathological response following neoadjuvant FOLFIRINOX in borderline resectable pancreatic cancer - a case report and review
Authors
Mišo Gostimir
Sean Bennett
Terence Moyana
Harman Sekhon
Guillaume Martel
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2821-0

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