Stage IV Pancreatic Cancer Patient Treated With FOLFIRINOX Combined With Oral Methioninase: A Highly-Rare Case With Long-term Stable Disease.

Abstract

BACKGROUND:

Pancreatic cancer is one of the most recalcitrant cancers, and more effective therapy is needed. Pre-clinical studies have shown that patient-derived orthotopic xenograft (PDOX) mouse models of pancreatic cancer are effectively treated with oral recombinant methioninase (o-rMETase).

CASE REPORT:

A 62-year-old woman diagnosed with stage IV pancreatic cancer was treated with the combination of 5-fluorouracil/leucovorin, irinotecan, and oxaliplatinum (FOLFIRINOX) every two weeks and o-rMETase twice a day as a supplement. The patient was also on a low-methionine diet. Disease progression was monitored by CA19-9 and computed tomography. The patient initially responded to FOLFIRINOX, shown by a great reduction in CA19-9 levels, with tumor shrinkage shown by computed tomography. The patient began taking o-rMETase and went on a low-methionine diet one year after diagnosis which she has maintained without side effects for 7 months. The patient's CA19-9 level and tumor size remain stable 19 months after diagnosis. The patient is alive and has maintained a high performance status. Historical data show that less than 5% of stage IV pancreatic-cancer patients on FOLFIRINOX have stable disease 1.5 years after diagnosis.

CONCLUSION:

The combination of o-rMETase and FOLFIRINOX may be synergistic in stage IV pancreatic cancer.

• Authors: Yutaro Kubota, Qinghong Han, Chihiro Hozumi, Noriyuki Masaki, Jun Yamamoto, Yusuke Aoki, Takuya Tsunoda, Robert M Hoffman
• Journal: Anticancer research (Anticancer Res) Vol. 42 Issue 5 Pg. 2567-2572 (May 2022) ISSN: 1791-7530 [Electronic] Greece
• PMID: 35489727 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Chemical References

• CA-19-9 Antigen
• folfirinox
• Oxaliplatin
• Irinotecan
• Methionine
• Carbon-Sulfur Lyases
• L-methionine gamma-lyase
• Leucovorin
• Fluorouracil

Topics

• Animals
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• CA-19-9 Antigen
• Carbon-Sulfur Lyases
• Disease Models, Animal
• Female
• Fluorouracil (therapeutic use)
• Humans
• Irinotecan (therapeutic use)
• Leucovorin (therapeutic use)
• Methionine
• Mice
• Mice, Nude
• Oxaliplatin
• Pancreatic Neoplasms (drug therapy, pathology)
• Xenograft Model Antitumor Assays