title: Intensified Neoadjuvant Chemotherapy with Nab-Paclitaxel plus Gemcitabine Followed by FOLFIRINOX in a Patient with Locally Advanced Unresectable Pancreatic Cancer.
abstract: The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.
authors.affiliation: Departments of Medical Oncology, University of Würzburg, Würzburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Kunzmann
authors.affiliation: Departments of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
authors.forename: Ken
authors.initials: K
authors.lastname: Herrmann
authors.affiliation: Departments of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bluemel
authors.affiliation: Departments of Medical Oncology, University of Würzburg, Würzburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kapp
authors.affiliation: Departments of Medical Oncology, University of Würzburg, Würzburg, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Hartlapp
authors.affiliation: Departments of Surgery, University of Würzburg, Würzburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steger
keywords: 5-Fluorouracil; Folinic acid; Gemcitabine; Irinotecan; Locally advanced disease; Nab-paclitaxel; Neoadjuvant chemotherapy; Oxaliplatin; Pancreatic cancer