Spontaneous Regression Of Pancreatic Cancer With Liver Metastases
Saade Lemus, P., Anderson, K., Smith, M., & Bullock, A. (2019). Spontaneous regression of pancreatic cancer with liver metastases. BMJ case reports, 12(5), e229619. https://doi.org/10.1136/bcr-2019-229619
View Original Source →Abstract
Spontaneous cancer regression is a rare event, scarcely reported among gastrointestinal malignancies. Pancreatic adenocarcinoma regression has been documented in five previous cases, none of which included liver metastases, and the mechanism by which this occurs is not known. A 56-year-old woman with history of discoid lupus, homocysteinemia and peripheral vascular disease was diagnosed with stage IV pancreatic ductal adenocarcinoma (PDA) metastatic to the liver. She received palliative chemotherapy with 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) for 6 months, complicated by mucositis, diarrhoea, vomiting and two Clostridium difficile colitis episodes. Cancer initially responded to chemotherapy. However, due to substantial toxicities, she decided to discontinue cytotoxic chemotherapy and focus on palliation alone. Thereafter, CT and carbohydrate antigen (CA) 19-9 showed further response and ultimately complete cancer regression that has persisted for 33 months after cessation of chemotherapy. This is the first report in the English literature showing spontaneous regression of a PDA with liver metastases. Two possible mechanisms are proposed: antitumoral autoimmunity and tumour hypoxia related to vascular disease.
Case Details
Disease Location
Pancreas, liver metastases
Personal Characteristics
56-year-old woman. History of discoid lupus, homocysteinemia and peripheral vascular disease with extensive surgical history of bypass interventions and thrombectomies.
Clinical Characteristics
Diagnosed with stage IV pancreatic ductal adenocarcinoma (pda) metastatic to the liver. She presented with postprandial left upper quadrant abdominal pain radiating to her back associated with nausea and a 17-pound unintentional weight loss. CT scan of the abdomen and pelvis identified a 2.5cm pancreatic body/tail mass and multiple liver lesions measuring up to 1cm. Core liver biopsy revealed adenocarcinoma with immunohistochemical stains compatible with pancreaticobiliary primary. The patient commenced palliative chemotherapy with folfirinox (5-fluorouracil, leucovorin, oxaliplatin and irinotecan). CT two months later showed response to treatment in both the pancreas and the liver. Her course was complicated by hospitalisations for clostridium difficile colitis the patient decided against further chemotherapy.
Remission Characteristics
Despite withholding chemotherapy, her tumour has continued to regress per imaging. It regressed during the 33 months since her last dose of cytotoxic chemotherapy.
Treatment & Mechanisms
Proposed Remission Mechanisms
Protective antitumoral immunogenicity in relation to c. Difficile infection and angiogenic effects on the tumour microenvironment.
Clinical Treatment
Biopsy folfirinox