title: Exceptional Response to Nanoparticle Albumin-Bound Paclitaxel and Gemcitabine in a Patient with a Refractory Adenocarcinoma of the Ampulla of Vater.
abstract: Ampullary carcinoma is a rare tumor and evidence on the treatment of recurrent metastatic disease is scarce. We report the case of a 60-year-old patient with an R0-resected node-positive adenocarcinoma of the papilla of Vater of an initially diagnosed intestinal subtype who developed pulmonary metastases 2 months after adjuvant gemcitabine chemotherapy and, subsequently, liver metastases. Palliative combination chemotherapy with standard regimens for intestinal-type adenocarcinoma (FOLFOX and FOLFIRI) failed. However, subsequent combination chemotherapy with nanoparticle albumin-bound paclitaxel and gemcitabine, a regimen with proven efficacy in metastatic adenocarcinoma of the pancreas, resulted in a durable, very good partial remission. Treatment was manageable and well tolerated. Primary tumor and metastatic tissue were reassessed by immunohistochemistry and had to be reclassified to a mixed phenotype containing predominant elements of the pancreatobiliary subtype. Our case suggests that combination chemotherapy with nanoparticle albumin-bound paclitaxel and gemcitabine could represent a promising option for the treatment of this rare disease and warrants further investigation within controlled clinical trials. Moreover, thorough characterization of ampullary carcinomas by histomorphology and additional immunohistochemistry should become mandatory in order to start a chemotherapeutic regimen tailored for the definitive subtype.
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine II, Würzburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kapp
authors.affiliation: Institute of Radiology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kosmala
authors.affiliation: Institute of Pathology, University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kircher
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine II, Würzburg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Luber
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine II, Würzburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Kunzmann
keywords: Adenocarcinoma of the ampulla of Vater; FOLFIRI; FOLFOX; Gemcitabine; Intestinal-type adenocarcinoma; Nanoparticle albumin-bound paclitaxel; Pancreatobiliary type