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Tumor Discovery Anti-PD1 for advanced pancreatic cancer

gemcitabine and the epidermal growth factor receptor In addition, findings from PET-CT suggested peritoneal
(EGFR) inhibitor, erlotinib, which is a tyrosine kinase metastasis in the patient. As shown as Figure 1A, albumin-
inhibitor of the catalytic domain of EGFR, was modestly bound paclitaxel and gemcitabine were administered for
superior to gemcitabine alone . The standard second-line six cycles starting February 2018, and the last cycle was
[7]
treatment is non-existent in PC. Therefore, clinical trial of performed in June 2018. During chemotherapy, heart failure
new agents for treating PC is important since it has a high was detected once in the patient, but the condition improved
mortality rate and therapeutic benefits of the currently after treatment. The patient condition was hence classified as
available treatment methods are typically modest. stable disease, and the drug was discontinued for 2 months.
The approval of several PD-1/PD-L1 and CTLA-4 In August 2018, the patient’s carcinoembryonic antigen
inhibitors in the recent years has radically transformed the (CEA) and CA 19-9 levels were 14 ng/ml and 25.8 ng/ml,
treatment landscape in many cancer types and opened up respectively. Abdominopelvic CT showed new nodules in
a new field called immune-oncology as a new treatment the right paracolic sulcus as well as medial descending colon,
approach against cancer . Despite major breakthrough, indicating a possible severe metastasis. Pelvic effusion and
[8]
shortcomings of immune checkpoint inhibitors (ICI) have multiple lymph nodes in the abdominal cavity (Figure 1B) were
been observed. roughly the same as before. The albumin-bound paclitaxel
and gemcitabine were continued for four cycles, during which
Here, we present a case of a patient with PC who was
treated with surgical resection, chemotherapy, molecular CEA level gradually increased to 31.9 ng/ml. After four cycles,
the right paracolic groove, the medial descending colon, the
targeted medicine, and anti-PD1 immunotherapy. The greater omentum, and the retroperitoneal left subphrenic
level of CA 19-9 and tumor size of the patient were nodules in the abdominal cavity appeared larger in size than
evaluated. The survival period of the patient was more than
6 years since the diagnosis of PC. At the end of the report, before. The bladder and rectum were also enlarged. In view of
we include our perspective on the future development of the above, the disease had become progressive.
immunotherapy for PC. In October 2018, the CEA and CA 19-9 levels were
52.6 ng/ml and 48.1 ng/ml, respectively. The patient started
2. Case presentation FOLFIRINOX chemotherapy regimen for four cycles,
In October 2014, a 66-year-old man was admitted to our and the treatment tolerance was acceptable. A review of
hospital. At the time of admission to the hospital, the patient treatment efficacy after four cycles showed that the disease
had an elevated level of CA 19-9, and positron emission had become stable, and the CEA and CA 19-9 levels were
tomography/computed tomography (PET-CT) examination 20.9 ng/ml and 48.9 ng/ml, respectively. FOUNDATION
indicated tumor at pancreatic body and tail. Intra-operative ONE gene sequencing was used to test for microsatellite
exploration found a small amount of ascites in the abdominal stability, tumor mutation burden 18Muts/Mb, and BRAF
cavity, a mass of 3 × 2 × 2 cm in size was detected near the T599_V600insT mutation. Immunohistochemical findings
splenic portal in the tail of the pancreas, which invaded showed that the patient was negative for PD-L1 and PD-1.
the lower pole of the spleen and the perirenal fat sac, and In December 2018, FOLFIRINOX+KEYTRUDA was
no enlarged lymph nodes were detected in the abdominal performed for a total of four cycles, and reexamination
cavity. Therefore, radical treatment of PC and splenectomy in February 2019 (Figure 1C) showed that multiple
was performed. Post-operative pathologic examination intraperitoneal implantation metastasis was diminished,
indicated the presence of a mucinous adenocarcinoma at the and at the same time, the CEA and CA 19-9 levels were
pancreatic body and tail, which was manifested as medium 9.73 ng/ml and 49 ng/ml, respectively. The efficacy of the
differentiation, invasion of peripancreatic fat, and one tumor treatment on partial remission was evaluated. KEYTRUDA
deposit. Pathologic staging of the tumor was pT2N0M0. Post- treatment was performed for 4 times from February 2019
operative CA 19-9 level dropped to normal. After six cycles to May 2019, In May 2019, the drug was replaced with
of gemcitabine and S-1 adjuvant chemotherapy, the regimen anlotinib (12 mg d1 – 14 q21d) + keytruda for a total of four
was replaced by single drug S-1 (two pills in the morning and cycles. Due to hand-foot syndrome, cough, and elevated
two pills at night) for the purpose of maintenance treatment, blood pressure, the dosage of anlotinib was reduced to
which was continued until January 2018, during which no 8 mg d1 – 14d q21d after two cycles. Immunotherapy
obvious abnormality was found in abdominal CT review was continued to be used the patient, who attended the
for 6 months. In January 2018, we found that a new mass follow-up sessions and periodic review. The treatment had
developed in the periumbilical scar. The mass was resected improved cancer pain and stabilized the patient’s condition
in the hospital. Post-operative pathologic examination and the disease had not progressed. Despite that, the
showed that the mass was a mucinous adenocarcinoma. patient still needs treatment and periodical follow-up.

Volume 1 Issue 1 (2022) 2 https://doi.org/10.36922/td.v1i1.52