Prolonged Complete Response after Neoadjuvant Capecitabine-Gemcitabine for a Locally Advanced Pancreatic Adenocarcinoma: A Case Report

Abstract

Background: Pancreatic duct adenocarcinoma is increasing in incidence without appreciable decrease in overall survival despite decades  of heightened research. Its mortality rate approaches its incidence rate. We report a case of carcinoma of the pancreas that had complete  response from adjuvant chemotherapy.

Case Presentation: A 39-year old male radiographer presented with a 3-month history of progressively worsening epigastric pain  radiating to the back, associated with history of weight loss, anorexia, and jaundice. Abdominal CT scan showed a mass in the head of  pancreas. A Whipple’s operation was planned for the patient. However, intraoperatively, the head and body of the pancreas were found to have been taken over by the tumor, which encased the portal vein as well. Multiple core needle biopsies of the pancreas were taken.  Cholecystojejunostomy, gastrojejunostomy, and jejunojejunostomy were then done. Histopathologic analysis of the specimen revealed a  well‑differentiated adenocarcinoma of the pancreas. He was commenced on 28-day cycle of gemcitabine 1000 mg/m² on Days 1, 8, and 15 plus capecitabine 830 mg/m² on Days 1–14. Repeat CT scan done after the 4th cycle showed no residual tumor in the pancreas. He has  been in good health after 36 months follow-up, having received eight cycles of chemotherapy. He was counseled on resection of the  pancreas, but he declined.

Conclusion: Complete radiologic response may rarely occur after adjuvant chemotherapy for locally advanced  adenocarcinoma of the pancreas. This does not, however, imply a cure of the disease.