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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Metastatic pancreatic and lung cancer patient in complete remission following immunotherapy: A case report and review of literature
Joaquina Martínez-Galán, Cristina Jiménez-Luna, Isabel Rodriguez, Elisabeth Maza, Carlos García-Collado, Antonio Rodríguez-Fernández, Javier Luis López-Hidalgo, Octavio Caba
Joaquina Martínez-Galán, Isabel Rodriguez, Elisabeth Maza, Department of Medical Oncology, Virgen de las Nieves University Hospital, Granada 18014, Spain
Joaquina Martínez-Galán, Cristina Jiménez-Luna, Isabel Rodriguez, Elisabeth Maza, Carlos García-Collado, Antonio Rodríguez-Fernández, Javier Luis López-Hidalgo, Octavio Caba, Instituto de Investigación Biosanitaria, Ibs. Granada, Granada 18012, Spain
Cristina Jiménez-Luna, Octavio Caba, Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada 18016, Spain
Carlos García-Collado, Pharmacogenetics Unit, Virgen de las Nieves University Hospital, Granada 18014, Spain
Antonio Rodríguez-Fernández, Department of Medicina Nuclear, Virgen de las Nieves University Hospital, Granada 18014, Spain
Javier Luis López-Hidalgo, Department of Anatomía Patológica, Virgen de las Nieves University Hospital, Granada 18014, Spain
Author contributions: Martínez-Galán J collected and analyzed the data, took care of the patient and wrote and edited the manuscript; Rodriguez I, Maza E contributed to collect and analyze the patient data; García-Collado C contributed to the patient's treatment; Rodríguez-Fernández A contributed to the acquisition and analysis of pathologic images; López-Hidalgo JL contributed to molecular diagnostics; Jiménez-Luna C contributed to critical revision and writing of the manuscript; Caba O contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cristina Jiménez-Luna, PhD, Senior Researcher, Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Avenida del Conocimiento, s/n, Granada 18016, Spain. crisjilu@ugr.es
Received: December 31, 2023
Peer-review started: December 31, 2023
First decision: January 27, 2024
Revised: February 9, 2024
Accepted: March 13, 2024
Article in press: March 13, 2024
Published online: May 15, 2024
BACKGROUND
Metastatic pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with dispiriting survival data. Immunotherapy is a promising approach to many cancer types, but achieves poor outcomes in advanced PDAC due to its immunosuppressive tumor microenvironment. We describe a case of metastatic PDAC effectively treated with pembrolizumab.
CASE SUMMARY
We report the case of a 67-year-old woman with unresectable locally advanced PDAC, treated with gemcitabine plus nab-paclitaxel followed by radiotherapy plus capecitabine. At nine months, pancreatic tumor progression was observed at the level of the hepatic hilum with the appearance of a new pulmonary nodule suggestive of a second primary, confirmed by left lung biopsy. Systemic immunotherapy was then initiated with pembrolizumab, an immune checkpoint inhibitor targeting programmed cell death protein-1 that covers the two tumor types. The patient showed a complete metabolic response that was maintained throughout the treatment. The patient continues to be disease-free at 5.6 years since the start of immunotherapy.
CONCLUSION
These results suggest that the administration of pembrolizumab after chemoradiotherapy has a beneficial effect in patients with metastatic PDAC. To our knowledge, this is the first reported case of a patient with metastatic PDAC and metastatic lung cancer showing such a long-lasting complete response after pembrolizumab treatment without curative surgery. Further studies are required to determine biomarkers that identify PDAC patients most likely to benefit from this immunotherapy.
Core Tip: The lack of specific symptoms in patients and the absence of a reliable and well-stablished diagnostic method, makes advanced pancreatic ductal adenocarcinoma (PDAC) the most common clinical appearance of pancreatic cancer cases. In these circumstances, surgical resection, the only curative approach for this malignancy, is unaffordable, leading to very low survival outcomes. Immunotherapy is a recent approach that has been studied in many cancer types showing encouraging results, but it has not been sufficiently investigated in PDAC. We report the case of a patient with unresectable PDAC that progressed to metastasis after treatment with chemoradiation, who showed an outstanding response to immunotherapy with pembrolizumab, achieving a complete remission within a few months, which was maintained until the end of treatment. Currently, the patient continues in disease-free state.
