Pathological complete response in a patient with metastatic pancreatic acinar cell carcinoma who received a chemotherapy regimen containing cisplatin and irinotecan

Maehira, Hiromitsu; Iida, Hiroya; Mori, Haruki; Nitta, Nobuhito; Tokuda, Aya; Takebayashi, Katsushi; Kaida, Sachiko; Miyake, Toru; Matsubara, Akiko; Tani, Masaji

doi:10.1007/s12328-021-01518-z

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Liver metastases were treated with surgery and RFA. The other metastases were all resected Newly detected liver metastases were treated with chemotherapy (nab-paclitaxel and panitumumab) 132 months Di marco et al [ 13 ] Metachronous Three liver metastases RFA Gemcitabine plus capecitabine No recurrence 68 months Di marco et al [ 13 ] Metachronous Two liver metastases RFA Gemcitabine plus capecitabine Recurrence at peritoneal tissue treated with systemic chemotherapy (capecitabine plus irinotecan, gemcitabine plus capecitabine) 86 months (dead) Hashimoto et al [ 14 ] Synchronous Two liver metastases Left hemi-hepatectomy and partial resection No Recurrence at liver (partial liver resection and hepatic arterial infusion with 5-FU, cisplatin, and mitomycin C) 63 months Jauch et al [ 15 ] Synchronous Solitary liver metastasis Right hemi-hepatectomy Capecitabine plus oxaliplatin Recurrence at liver (complete eradication by chemotherapy) 42 months Maehira et al [ 16 ] Metachronous Multiple liver metastases, local recurrence The removal of multiple liver metastases and local recurrence in the pancreatic bed Cisplatin plus irinotecan No recurrence 57 months Ohara et al [ 17 ] Metachronous Solitary liver metastasis, rectum Right posterior sectorectomy and abdominoperitoneal resection No No recurrence 40 months …”

Section: Discussionmentioning

confidence: 99%

A resected case of acinar cell carcinoma of the pancreas with liver metastasis following chemotherapy using modified FOLFIRINOX

Yamada,

Motegi,

Kurihara

et al. 2023

surg case rep

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Background Acinar cell carcinoma of the pancreas is a rare exocrine malignancy representing less than 1% of all pancreatic neoplasms. It has been reported that it responds to treatment differently from pancreatic ductal adenocarcinoma and the treatment algorithm for acinar cell carcinoma usually depends on the stage of the respective tumor and the patient’s current status. Case presentation A 60-year-old man presented with upper abdominal pain and anorexia. Abdominal ultrasonography showed a large-sized hepatic mass and he was referred to our hospital. Contrast-enhanced computed tomography demonstrated a 110-mm low-density area occupying the right hemi-liver and an enhanced mass of 70 × 56 mm in the tail of the pancreas, which seemed to directly infiltrate into the spleen. The case was diagnosed as acinar cell carcinoma with a simultaneous liver metastasis identified by liver biopsy. Upfront resection of pancreatic cancer with distant metastasis might not be considered as an optimal choice, and in this case chemotherapy was administered prior to curative resection. Chemotherapy using the modified FOLFIRINOX regimen was undertaken, resulting in a partial remission; the liver tumor reduced in size from 110 to 47 mm and the pancreatic tumor from 70 to 40 mm. The patient then safely underwent curative hepatic resection with distal pancreato-splenectomy. Histological examinations revealed small-sized atypical cells with large nuclei that had formed acinar patterns, and immunostaining with trypsin was positive in tumor cells, which was in accordance with acinar cell carcinoma. More than 3 years later, the patient is doing well without any recurrence. Conclusion Aggressive and curative surgery in combination with chemotherapy such as FOLFIRINOX could be a treatment option to achieve long-term survival in cases of acinar cell carcinoma with liver metastases.

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Section: Discussionmentioning

confidence: 99%

A resected case of acinar cell carcinoma of the pancreas with liver metastasis following chemotherapy using modified FOLFIRINOX

Yamada,

Motegi,

Kurihara

et al. 2023

surg case rep

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“…A complete response to the RAF/MEK inhibitor combination of dabrafenib/trametinib has been reported in 2 patients with tumors bearing BRAF V600E mutation [182,183] . Treatment with alectinib of a metastatic PACC patient with a somatic KANK4/ALK fusion resulted in a partial response ongoing at 1 year [184] . The use of immunotherapy in a PACC patient with high tumor mutational burden and tumor PD-L1 expression resulted in a partial response that permitted subsequent re-resection with continued absence of disease [185] .…”

Section: Advanced Diseasementioning

confidence: 99%

“…Treatment with alectinib of a metastatic PACC patient with a somatic KANK4/ALK fusion resulted in a partial response ongoing at 1 year [ 184 ] . The use of immunotherapy in a PACC patient with high tumor mutational burden and tumor PD-L1 expression resulted in a partial response that permitted subsequent re-resection with continued absence of disease [ 185 ] . It is very clear that precision medicine is of significant benefit to PACC patients with actionable tumor genetics and providers should advocate for sequencing of available tumor material to expand treatment options.…”

Section: Pancreatic Acinar Cell Carcinoma (Pacc)mentioning

confidence: 99%

Two rare cancers of the exocrine pancreas: to treat or not to treat like ductal adenocarcinoma?

2023

J Cancer Metastasis Treat

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Pancreatic cancer is an aggressive malignancy with increasing incidence. Pancreatic ductal adenocarcinoma (PDAC) accounts for > 90% of pancreatic cancer diagnoses, while other exocrine tumors are much rarer. In this review, we have focused on two rare cancers of the exocrine pancreas: adenosquamous carcinoma of the pancreas (ASCP) and pancreatic acinar cell carcinoma (PACC). The latest findings regarding their cellular and molecular pathology, clinical characteristics, prognosis, and clinical management are discussed. New genetic and transcriptomic data suggest that ASCP is related to or overlaps with the basal transcriptomic subtype of PDAC. These tumors are highly aggressive and driven by activated KRAS and MYC expression. Clinical outcomes remain poor and effective treatments are limited. PACC has no morphologic or genetic resemblance to PDAC and more favorable outcomes. Early stage PACC patients have improved survival with surgical resection and patients with advanced disease benefit most from platinum-or fluoropyrimidine-containing chemotherapy. Frequency of actionable genetic mutations is high in this disease and case reports suggest good outcomes when matched therapy is given. Dedicated clinical studies examining ASCP and PACC are limited and difficult to accrue. Further research is needed to define optimal clinical management for these rare diseases.

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A case of unresectable ectopic acinar cell carcinoma developed in the portal vein in complete response to FOLFIRINOX therapy

Nakayama

Fukuda

Kou

et al. 2023

Clin J Gastroenterol

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Pathological complete response in a patient with metastatic pancreatic acinar cell carcinoma who received a chemotherapy regimen containing cisplatin and irinotecan

Cited by 3 publications

References 20 publications

A resected case of acinar cell carcinoma of the pancreas with liver metastasis following chemotherapy using modified FOLFIRINOX

A resected case of acinar cell carcinoma of the pancreas with liver metastasis following chemotherapy using modified FOLFIRINOX

Two rare cancers of the exocrine pancreas: to treat or not to treat like ductal adenocarcinoma?

A case of unresectable ectopic acinar cell carcinoma developed in the portal vein in complete response to FOLFIRINOX therapy

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