Durable response for ampullary and duodenal adenocarcinoma with a nab‐paclitaxel plus gemcitabine ± cisplatin combination

Abstract

Background/Aim There is no standard salvage chemotherapy for metastatic periampullary adenocarcinoma and duodenal adenocarcinoma and the prognosis of those who fail oxaliplatin, irinotecan, and 5FU is dismal. We examined nanoparticle albumin‐bound paclitaxel (nab‐paclitaxel) as salvage therapy for these two malignancies. Methods Patients who failed oxaliplatin, irinotecan, and 5FU and whose archival tumors stained immunohistochemical (IHC) tumor positive for CK7 or MUC1 received nab‐paclitaxel and gemcitabine therapy with or without cisplatin. Results Three patients, 2 with metastatic ampullary adenocarcinoma and 1 with duodenal adenocarcinoma with positive IHC staining for CK7 or MUC1 who failed 2 lines of chemotherapy with oxaliplatin, irinotecan, and 5FU received nab‐paclitaxel and gemcitabine with or without cisplatin. All achieved excellent tumor response on CT scans with marked falls in tumor markers CA19‐9 and CEA as well as ≥1 year of progression‐free survival. All 3 have continued to survive 2‐3 years since diagnosed with stage 4 metastatic adenocarcinoma. Conclusions Nab‐paclitaxel plus gemcitabine with or without cisplatin should be investigated as a standard‐of‐care chemotherapy regimen for patients with ampullary adenocarcinoma and duodenal adenocarcinoma.

Metastatic small bowel adenocarcinoma: role of metastasectomy and systemic chemotherapy

“…This finding, which has been identified in a few small reports, supports the inclusion of taxane-based chemotherapy as an option beyond the first line in the NCCN guidelines. 8 , 25 , 26 , 27 Though used in a limited number of patients, neither TAS-102 nor regorafenib appeared to demonstrate meaningful activity with best response of PD seen in four of the five patients.…”

Ampullary Cancer: Histological Subtypes, Markers, and Clinical Behaviour—State of the Art and Perspectives

“…Looking at the cellular contents of lesions, both ampullary and duodenal adenocarcinomas have been treated in a similar way; the treatment regimens were close to cholangiocarcinoma or colon cancer. Pharmacological regimens included gemcitabine w/wo platinum compounds (cis-or oxali-) [62] or Capacitabine and Oxaliplatinum [63,64]. Another pharmacological treatment involved the fluoropyrimidine-based chemotherapy (FOLFOX or FOLFIRI).…”

“…Furthermore, some authors in 2019 changed the third line of chemotherapy in three AAC patients, looking for their immunophenotypical characterizations. A group of scientists performed analyses of CK7, CK20, MUC1, and CDX2 in tumour tissues of patients [62]. The IHC analyses were suggestive for the PB subtype for two patients and the INT subtype for the third one.…”

Prognostic nomogram for ampullary adenocarcinoma patients with liver metastasis: Results from SEER database and National Cancer Center of China

“…Several RCT studies have shown that postoperative adjuvant chemotherapy for periampullary carcinoma does not improve patient survival [11][12][13][14]. Notably, most of the currently recommended chemotherapy regimens for AC were extrapolated from limited phase II clinical trials [15].…”