Case Report

Durable effect of imatinib and metronomic chemotherapy with capecitabine in pancreatic carcinoma

21 Apr 2023
Sana Al-Sukhun, Karim Khalidi

Background: Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery (median survival: <30 months). The prognosis of borderline resectable pancreatic cancer (BR-PDC) is even worse. We describe a patient with BR-PDC who achieved stable disease with metronomic chemotherapy after refusing surgery.

Case presentation: A 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, Fine needle aspiration (FNA) confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy. After the second cycle of mFOLFIRINOX – complicated by febrile neutropenia – she refused further IV therapy. Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis. The patient did well and she is currently alive with a stable disease as of 2 years after diagnosis.

Conclusion: Metronomic chemotherapy, especially capecitabine added to the targeted therapy, imatinib, is a potentially useful treatment for PDC where no other options are available, especially those harbouring no mutation in the dominant four genes. Indeed, the absence of mutation with KIT amplification could be a potential marker for improved outcomes with targeted and metronomic therapy, which deserves further evaluation in a clinical trial setting.

Artículos relacionados

G Luis Pendola, Roberto Elizalde, Pablo Sitic Vargas, José Caicedo Mallarino, Eduardo Gonzalez, José Parada, Mauricio Camus, Ricardo Schwartz, Enrique Bargalló, Ruffo Freitas, Mauricio Magalhaes Costa, Vilmar Marques de Oliveira, Paula Escobar, Miguel Oller, Luis Fernando Viaña, Antonio Jurado Bambino, Gustavo Sarria, Francisco Terrier, Roger Corrales, Valeria Sanabria, Juan Carlos Rodríguez Agostini, Gonzalo Vargas Chacón, Víctor Manuel Pérez, Verónica Avilés, José Galarreta, Guillermo Laviña, Jorge Pérez Fuentes, Lía Bueso de Castellanos, Bolívar Arboleda Osorio, Herbert Castillo, Claudia Figueroa
Daniela Speisky, Mariano Villarroel, Felix Vigovich, Alejandro Iotti, Teresa Adriana García, Luciana Bella Quero, Mariano Bregante, María Teresa García de Davila
Emilia Pardal de la Mano, Guillermo Martín-Sánchez, Rosa López López, M Angeles Fernández Galán, Sergio Trinidad Ríos, M José Morán Jiménez, J María García Ruiz de Morales, M Antonia Crespo Santos, Guillermo Martín Núñez
Sebastián Mondaca, Valentina Hornig, Pablo Munoz-Schuffenegger, Francisco Acevedo, Marcelo Garrido, Bruno Nervi
Daniela Speisky, María Teresa García de Davila, Felix Vigovich, Julian Mendez, Rafael Maurette, Marcos García Ejarque, Juan Carlos Spina, Alejandro Iotti, Pablo Dezanzo