Leptomeningeal Carcinomatosis in a Patient with Pancreatic Cancer Responding to Nab-Paclitaxel plus Gemcitabine

Abstract

Leptomeningeal carcinomatosis is an extremely rare, but devastating complication in pancreatic cancer patients with a poor prognosis despite multimodal treatment. We present a 51-year-old male patient with the very rare condition of leptomeningeal carcinomatosis originating from pancreatic cancer. He presented to our hospital with severe headache and neck stiffness 30 months after systemic chemotherapy. Cerebral and spinal MRI as well as cerebrospinal fluid examination confirmed the diagnosis of leptomeningeal carcinomatosis. The patient responded to gemcitabine plus nab-paclitaxel in terms of elimination of tumor cells from the CSF and concurrent clinical improvement for 3 months. The observed findings suggest that the combination of gemcitabine plus nab-paclitaxel is potentially effective in affected cerebrospinal fluid of pancreatic carcinoma patients.

Treatment Outcome of Nab-paclitaxel Plus Gemcitabine for Leptomeningeal Carcinomatosis from Pancreatic Ductal Adenocarcinoma: An Autopsy Case Report

“…This result might indicate that nab-PTX + GEM can provide a longer survival period than other regimens (e.g., (11,15,19). However, nab-PTX + GEM seems to be insufficient to suppress LMC progression because our patient eventually died of LMC progression, as did the patient described by Ceccon et al (25). A possible reason for these outcomes might be the poor intracerebral fluid transferability of nab-PTX + GEM.…”

“…However, only one report has focused on the treatment outcomes for LMC from PDAC. In this report, Ceccon et al ( 25 ) described a 51-year-old man with LMC from PDAC that responded to nab-PTX+GEM in terms of elimination of tumor cells from the CSF and concurrent long-term clinical improvement (3 months after diagnosis of LMC). The patient finally developed neurogenic disorders associated with LMC progression (palsies of cranial nerves, gait disorder, and severe consciousness impediment) and soon died.…”

“…Nevertheless, nab-PTX + GEM appears to be a reasonable treatment. Previous reports have indicated that it seems to be a relatively effective regimen (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Moreover, combinations of fluorouracil + leucovorin + irinotecan + oxaliplatin and erlotinib + gemcitabine are used as first-line regimens for unresectable PDAC, as with nab-PTX + GEM; however, no articles have described the treatment outcomes of these regimens for LMC from PDAC.…”

“…In patients with pancreatic ductal adenocarcinoma (PDAC), metastasis to the central nervous system (CNS) is generally rare (occurring in approximately 0.3% of all cases) (8). In particular, the development of LMC metastasis is quite rare: only 17 cases of LMC from PDAC have been reported to date (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). LMC is a serious complication of PDAC with an extremely poor prognosis and limited treatment options.…”

“…LMC is a serious complication of PDAC with an extremely poor prognosis and limited treatment options. Few articles to date have described the treatment approach for LMC from PDAC ( 11 , 13 - 15 , 18 , 19 , 23 , 25 ). In this report, we present an autopsy case of LMC from PDAC in a patient who was treated with nab-paclitaxel plus gemcitabine (nab-PTX+GEM).…”