title: Complete pathological remission of locally advanced, unresectable pancreatic cancer (LAPC) after intensified neoadjuvant chemotherapy.
abstract: BACKGROUND
  Unresectable locally advanced pancreatic cancer (LAPC) has an extremely poor prognosis. Results of neoadjuvant (radio-)chemotherapy approaches aiming at achieving resectability are currently not satisfactory.
  
  
  METHODS
  We report the case of a 67-year-old woman with histologically confirmed pancreas carcinoma that was not resectable on first surgical exploration who achieved a well-documented complete pathological remission (pCR). The carcinoma became resectable after consecutive neoadjuvant treatment with nanoparticle albumin-bound (nab)-paclitaxel/gemcitabine and FOLFIRINOX chemotherapy regimens.
  
  
  CONCLUSIONS
  This is the first reported LAPC case in which neoadjuvant chemotherapy alone has been shown to lead to demonstrated pCR. CA19-9 levels, but not imaging criteria, were useful for response prediction and timing of the Whipple's procedure. The findings in this case suggest possible conceptual changes in the treatment approach for LAPC, and indicate that the new effective chemotherapy regimens should be integrated into clinical trials for LAPC.
authors.affiliation: Department of Internal Medicine II, University of Würzburg, Germany. hartlapp_i@klinik.uni-wuerzburg.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Hartlapp
authors.forename: Justus
authors.initials: J
authors.lastname: Müller
authors.forename: Werner
authors.initials: W
authors.lastname: Kenn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steger
authors.forename: Christoph
authors.initials: C
authors.lastname: Isbert
authors.forename: Michael
authors.initials: M
authors.lastname: Scheurlen
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Volker
authors.initials: V
authors.lastname: Kunzmann
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D020360:Neoadjuvant Therapy / Q000379:methods; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012074:Remission Induction; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000077146:Irinotecan; D017239:Paclitaxel; D005472:Fluorouracil; D002166:Camptothecin; D000093542:Gemcitabine