FOLFIRINOX as First-Line Treatment for Unresectable Acinar Cell Carcinoma of the Pancreas: A Case Report

Abstract

Pancreatic acinar cell carcinoma (ACC) is a rare, aggressive variant of pancreatic ductal adenocarcinoma. Surgery is the only curative treatment option and protocols for palliative chemotherapies in this context are not standardized yet. We reported a 63-year-old white male patient who had painless jaundice, weight loss, elevated bilirubin, and a mass of the pancreatic head as well as liver metastasis. Core biopsy revealed the diagnosis of ACC. Therapy with FOLFIRINOX resulted in a significant decrease of the primary tumor and regressiveness of a liver metastasis after chemotherapy. Our report suggests that pancreatic ACC treated by FOLFIRINOX is well tolerated and might be superior to other single chemotherapies in this rare tumor disease.

Zusammenfassung

Azinuszellkarzinome (ACC) des Pankreas sind seltene Varianten des duktalen Adenokarzinoms des Pankreas. Die Chirurgie ist die einzige kurative Therapieoption und Protokolle für palliative Chemotherapien sind in diesem Zusammenhang noch nicht standardisiert. Wir berichten über einen 63-jährigen, weißen Patienten, der sich mit schmerzlosen Ikterus, Gewichtsverlust, erhöhtem Bilirubin sowie einem Pankreaskopftumor und Lebermetastase vorstellte. Die bioptische Sicherung der Pankreasläsion ergab den Nachweis eines ACC. Eine Therapie mit FOLFIRINOX führte zu einer signifikanten Verkleinerung des Primärtumors und einer Rückläufigkeit der Lebermetastase. Unser Fallbericht zeigt, dass FOLFIRINOX eine gut verträgliche Therapiemöglichkeit des inoperablen ACC darstellt und möglicherweise überlegen zu anderen chemotherapeutischen Substanzen ist .

Schlüsselwörter

Azinuszellkarzinom (ACC) - FOLFIRINOX - Pankreas

Key words

acinar cell carcinoma (ACC) - FOLFIRINOX - pancreas

• References

• 1 Holen KD, Klimstra DS, Hummer A et al. Clinical characteristics and outcomes from an institutional series of acinar cell carcinoma of the pancreas and related tumors. J Clin Oncol 2002; 20: 4673-4678
• 2 Chen J, Baithun SI. Morphological study of 391 cases of exocrine pancreatic tumours with special reference to the classification of exocrine pancreatic carcinoma. J Pathol 1985; 146: 17-29
• 3 Cubilla AL, Fitzgerald PJ. Morphological patterns of primary nonendocrine human pancreas carcinoma. Cancer Res 1975; 35: 2234-2248
• 4 Cubilla AL, Fitzgerald PJ. Cancer of the pancreas (nonendocrine): a suggested morphologic classification. Semin Oncol 1979; 6: 285-297
• 5 Cubilla AL, Fitzgerald PJ. Classification of pancreatic cancer (nonendocrine). Mayo Clin Proc 1979; 54: 449-458
• 6 Morohoshi T, Held G, Kloppel G. Exocrine pancreatic tumours and their histological classification. A study based on 167 autopsy and 97 surgical cases. Histopathology 1983; 7: 645-661
• 7 Lowery MA, Klimstra DS, Shia J et al. Acinar cell carcinoma of the pancreas: new genetic and treatment insights into a rare malignancy. Oncologist 2011; 16: 1714-1720
• 8 Yamamoto T, Ohzato H, Fukunaga M et al. Acinar cell carcinoma of the pancreas: a possible role of S-1 as chemotherapy for acinar cell carcinoma. A case report. JOP 2012; 13: 87-90
• 9 Lee JL, Kim TW, Chang HM et al. Locally advanced acinar cell carcinoma of the pancreas successfully treated by capecitabine and concurrent radiotherapy: report of two cases. Pancreas 2003; 27: e18-e22
• 10 Simon M, Bioulac-Sage P, Trillaud H et al. FOLFOX regimen in pancreatic acinar cell carcinoma: case report and review of the literature. Acta Oncol 2012; 51: 403-405
• 11 Morales M, Cabrera MA, Maeso MD et al. Use of panitumumab in the treatment of acinar cell carcinoma of the pancreas: A case report. Oncol Lett 2013; 5: 969-971
• 12 Seki Y, Okusaka T, Ikeda M et al. Four cases of pancreatic acinar cell carcinoma treated with gemcitabine or S-1 as a single agent. Jpn J Clin Oncol 2009; 39: 751-755
• 13 Conroy T, Desseigne F, Ychou M et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364: 1817-1825
• 14 Chen CP, Chao Y, Li CP et al. Concurrent chemoradiation is effective in the treatment of alpha-fetoprotein-producing acinar cell carcinoma of the pancreas: report of a case. Pancreas 2001; 22: 326-329
• 15 Butturini G, Pisano M, Scarpa A et al. Aggressive approach to acinar cell carcinoma of the pancreas: a single-insitution experience and a literature review. Langenbecks Arch Surg 2011; 396: 363-369
• 16 Riechelmann RP, Hoff PM, Moron RA et al. Acinar cell carcinoma of the pancreas. Int J Gastrointest Cancer 2003; 34: 67-72
• 17 Sorscher SM. Metastatic acinar cell carcinoma of the pancreas responding to gemcitabine, 5-fluorouracil and leucovorin therapy: a case report. Eur J Cancer Care (Engl) 2009; 18: 318-319
• 18 Distler M, Rückert F, Dittert DD et al. Curative resection of a primarily unresectable acinar cell carcinoma of the pancreas after chemotherapy. World J Surgical Oncology 2009; 7: 22
• 19 Antoine M, Khitrik-Palchuk M, Saif MW. Long-term survival in a patient with acinar cell carcinoma of pancreas. A case report and review of literature. JOP 2007; 8: 783-789
• 20 Armstrong MD, Von Hoff D, Barber B et al. An effective personalized approach to a rare tumor: Prolonged survival in metastatic pancreatic acinar cell carcinoma based on genetic analysis and cell line development. J Cancer 2011; 2: 142-152