Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9134
Peer-review started: March 22, 2021
First decision: July 5, 2021
Revised: July 13, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: October 26, 2021
Pancreatic cancer (PC) is a leading cause of cancer-related death, given its poor prognosis and the limited benefits of traditional therapies. As tumors become more genetically disorganized as they progress, genetic mutations might become new markers for us to predict their behavior. Nowadays, many inhibitors can selectively target gene products as a form of targeted therapy, with some showing promise as treatment for various types of cancer.
We describe a rare case of a PC patient with long-term survival of more than 8 yr. The patient was diagnosed with pancreatic ductal adenocarcinoma (PDAC) with BAP1 and PIK3CA gene mutations and Raf1 fusion and achieved partial response twice after treatment with apatinib in combination with chemotherapy.
BAP1, PIK3CA mutations, and Raf1 fusion are rare in PDAC. Patients with these three gene alterations of PDAC may achieve long-term survival with apatinib. Further research in other contexts is needed to determine whether apatinib has ideal efficacy for PC treatment.
Core Tip: We report a patient with pancreatic ductal adenocarcinoma (PDAC) possessing exceptionally rare RAF1, BAP1 and PIK3CA gene alterations who achieved partial response to apatinib combination therapy twice and experienced long-term survival. Until now, there have been no reports of a long-term PDAC patient with RAF1, BAP1 and PIK3CA aberrations who did not also have K-Ras, TP53, p16/ CDKN2A, or SMAD4 gene alterations. In such a rare case, we presume that PDAC with this special genetic alteration pattern might be converted to a kind of indolent cancer, which presents fewer symptoms and indicates a good prognosis for pancreatic cancer patients.