Title : Case presentation: Patient with metastatic pancreatic adenocarcinoma treated with nanoliposomal irinotecan combination therapy
Abstract:
Pancreatic cancer is the fourth most fatal cancer in both men and women. Patients usually remain asymptomatic until advanced stages of disease, and prognosis has not improved over the past 20 years. However, new treatment options for locally advanced and metastatic disease have emerged in the last years, including newer nanoparticle formulations of previously existing active substances. In 2013, after showing superiority to gemcitabine monotherapy, albumin-bound paclitaxel (in combination with gemcitabine) emerged as a 1st line treatment option for patients with metastatic disease and with good performance status. More recently, nanoliposomal irinotecan (in combination with 5-fluorouracil and leucovorin) was introduced as a 2nd line option for metastatic pancreatic cancer in adult patients with disease progression following gemcitabine based therapy. We present the first case of treatment with nanoliposomal irinotecan in Slovenia.
A 69-year old female patient was first diagnosed with metastatic pancreatic adenocarcinoma in August 2015. Computer tomography (CT) demonstrated a tumor in the transition body/tail region of the pancreas with encasement of splenic vein. Multiple metastatic lesions were seen in 6th and 8th liver segments. Serum CEA and CA 19-9 levels were grossly elevated. Diagnosis was confirmed with ultrasound-guided biopsy. In the following two years, several chemotherapy regimens, including gemcitabine-nab-paclitaxel combination therapy, FOLFIRINOX (5 fluorouracil, leucovorin, irinotecan and oxaliplatin combination therapy), gemcitabine monotherapy, and transarterial chemoembolization with doxorubicin drug-eluting beads for liver metastases, showed good responses with disease regression and localized pain reduction. Switches in regimens were performed due to various toxicities. Grade III peripheral neuropathy with paresthesias in fingers and toes, and alopecia universalis appeared during gemcitabine-nab-paclitaxel regimen. Persistent grade III neurotoxicity with formication, and grade II/III nausea and vomiting required discontinuation of FOLFIRINOX regimen. After seeing disease progression with gemcitabine monotherapy, a new treatment regimen with nanoliposomal irinotecan (in combination with 5-fluorouracil and leucovorin) was introduced in September 2017. There was a partial remission seen after 6 cycles, but a quick disease progression with increase in laboratory markers followed after a short pause in the treatment. However, CT scan showed no progression of the disease, and therefore, chemotherapy was reinstituted. Low grade adverse events of this regimen included diarrhea, nausea and fatigue. Thus far, patient received 11 cycles of nanoliposomal irinotecan, and remained in good condition after over 2.5 years of receiving chemotherapy. According to last CT scan, there has been a progression in size of one of the liver metastases, while the primary tumor and other liver metastases remained stable. New nanoparticle chemotherapy formulations played a significant role in the treatment success of presented patient.
Audience take away:
• New nanoliposomal technologies are changing the clinical practice and are becoming commonly used as a treatment strategy for metastatic pancreatic cancer.
• Nanoliposomal irinotecan in combination with 5-fluorouracil and leucovorin is a promising second line option for the treatment of metastatic pancreatic cancer.
• With a careful selection of treatment strategies in patients with good performance status in metastatic pancreatic disease, quality and duration of life may be significantly increased.
