Complete Pathologic Response of Pancreatic Adenocarcinoma to Chemotherapy (FOLFIRINOX) is not equal to Cure: Case Report and Review of the Literature

Gioia Pozza, Alice Tonello, Giuseppe Patanè, Isabella Paladina, Michele Valmasoni, Stefano Meriglianoand Cosimo Sperti

Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
Department of Oncology, Veneto Institute of Oncology (IOV), Italy

^*Correspondance to: Cosimo Sperti 

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Abstract:

Pancreatic ductal adenocarcinoma may present as locally advanced disease in a significant percentage of patients. Recently, the potent FOLFIRINOX regimen was shown to significantly prolong survival in advancedpancreatic ductal adenocarcinoma. We herein report a case of complete tumor response after FOLFIRINOX treatment of alocally advanced pancreatic cancer that was successfully resected. A 68-year-old woman was hospitalized in July 2014, for a 2-months history of right abdominal pain and weight loss. Abdominal US and CT showed a 3 cm mass involving the uncinated process of the pancreas and the retroperitoneal tissue with a pathologically enlarged left para-aortic nodes until iliac artery bifurcation. Ca 19-9 levels were 159.2 U/mL (normal value <37 U/mL). US-guided percutaneous biopsy of the mass showed poorly differentiated adenocarcinoma of the pancreas, and the patient was referred to neo-adjuvant therapy with FOLFIRINOX (6 cycles). Ca 19-9 serum levels normalized and CT examination showed reduction of the tumor (2.3 cm) together with para-aortic lymph nodes (<1 cm). 18-FDG PET/CT did not show any pathological uptake of the radiotracer. In December 2014, the patient underwent pylorus-preserving pancreaticoduodenectomy. Pathological examination did not show residual cancer cells, and no adjuvant therapy was administered. Sixteen months after surgery, brain metastasis occurred in absence of other sites of recurrence. Pathological examination of resected specimen confirmed brain metastasis from pancreatic adenocarcinoma. One month later, CT-scan showed multiple brain metastases, treated with palliative stereotactic radiotherapy. Currently, the patient is alive 22 months after pancreatic resection. Although rare, complete pathologic response of pancreatic adenocarcinoma after neoadjuvant therapy may occur, but this does not mean cure because tumor’s recurrence may happen.

Keywords:

Neoadjuvant chemotherapy; Pancreas; Pancreatic cancer; Pathological response

Cite the Article:

Pozza G, Tonello A, Patanè G, Paladina I, Valmasoni M, Merigliano S, et al. Complete Pathologic Response of Pancreatic Adenocarcinoma to Chemotherapy (Folfirinox) is not equal to Cure: Case Report and Review of the Literature. Clin Oncol. 2016; 1: 1146.