Background/Aim: Gemcitabine is standard first-line treatment for patients with advanced pancreatic cancer, however the efficacy is limited. Although acquired drug resistance and side-effects are known to limit efficacy, opposite effects of a drug, which enhance the malignancy of treated cancer, have been observed but are not well understood. The aim of the present study was to determine whether gemcitabine has such opposite effects on the BxPC-3 human pancreatic cancer cell line expressing green fluorescent protein in an orthotopic mouse model. Materials and Methods: BxPC-3-GFP tumors grown subcutaneously in nude mice were harvested. Tumor fragments were orthotopically implanted in the tail of the pancreas of nude mice using the technique of surgical orthotopic implantation. The BxPC-3-GFP orthotopic models were divided randomly into three groups: Group 1: untreated control; Group 2: low-dose gemcitabine (weekly intraperitoneal injection at 25 mg/kg for 6 weeks); Group 3: high-dose gemcitabine (weekly intraperitoneal injection at 125 mg/kg for 6 weeks). Each group comprised eight mice. Tumor size, fluorescent area of metastases, and body weight were measured. Results: Low-and high-dose gemcitabine inhibited primary tumor growth in a dose-dependent manner, and to the greatest extent by high-dose gemcitabine compared to the untreated control (p=0.0134). In contrast, the extent of metastasis on the peritoneum was significantly increased by low-dose gemcitabine compared to the untreated control (p=0.0112). The extent of metastasis showed no significant difference between the untreated control and mice treated with high-dose gemcitabine. Body weight of the treated mice was not significantly different from that of the untreated mice.
Conclusion: The use of very bright GFP expressing of BxPC-3 cells and the orthotopic model demonstrated an unexpected increase in metastasis by low-dose gemcitabine. Future experiments will investigate the mechanism of this phenomenon.Pancreatic cancer accounts for approximately 3% of all cancer in the United States and about 7% of all cancer deaths (1). The 5-year survival rate of patients diagnosed with pancreatic cancer is still only 9%, despite improvements in the past decade. Gemcitabine has been standard first-line treatment for patients with advanced pancreatic cancer since 1997 (2). Although many clinical trials tested new chemotherapy drugs combined with gemcitabine for pancreatic cancer, only combination therapy with nab-paclitaxel has been shown to be superior to gemcitabine alone (3).The efficacy of chemotherapy against pancreatic cancer is limited in most cases due to drug resistance. Chemotherapy itself may induce some changes in the tumor microenvironment which can promote cancer cell proliferation and metastasis (4). We previously showed that the chemotherapeutic cyclophosphamide actually enhanced the malignancy of implanted 5339 This article is freely accessible online.