Early relapse on adjuvant gemcitabine associated with an exceptional response to 2nd line capecitabine chemotherapy in a patient with pancreatic adenosquamous carcinoma with strong intra-tumoural expression of cytidine deaminase: a case report.
Antimetabolites, Antineoplastic
/ administration & dosage
Carcinoma, Adenosquamous
/ diagnosis
Chemotherapy, Adjuvant
Cytidine Deaminase
/ genetics
Deoxycytidine
/ administration & dosage
Female
Gene Expression
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Middle Aged
Pancreatic Neoplasms
/ diagnosis
Recurrence
Retreatment
Tomography, X-Ray Computed
Treatment Outcome
Gemcitabine
Cytidine deaminase
Drug metabolism
Gemcitabine
Pancreatic adenosquamous carcinoma
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
15 Jan 2020
15 Jan 2020
Historique:
received:
22
03
2019
accepted:
06
01
2020
entrez:
17
1
2020
pubmed:
17
1
2020
medline:
9
9
2020
Statut:
epublish
Résumé
Pancreatic adenosquamous carcinoma has a poor prognosis, with limited prospective trial data to guide optimal treatment. The potential impact of drug metabolism on the treatment response of patients with pancreatic adenosquamous carcinoma is largely unknown. We describe the case of a 51 year old woman with pancreatic adenosquamous carcinoma who, following surgical resection, experienced early disease relapse during adjuvant gemcitabine therapy. Paradoxically, this was followed by an exceptional response to capecitabine therapy lasting 34.6 months. Strong expression of cytidine deaminase was detected within the tumour. This case study demonstrates that early relapse during adjuvant chemotherapy for pancreatic adenosquamous carcinoma may be compatible with a subsequent exceptional response to second line chemotherapy, an important observation given the poor overall prognosis of patients with adenosquamous carcinoma. Cytidine deaminase is predicted to inactivate gemcitabine and, conversely, catalyze capecitabine activation. We discuss strong intra-tumoural expression of cytidine deaminase as a potential mechanism to explain this patient's disparate responses to gemcitabine and capecitabine therapy, and highlight the benefit that may be gained from considering similar determinants of response to chemotherapy in clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
Pancreatic adenosquamous carcinoma has a poor prognosis, with limited prospective trial data to guide optimal treatment. The potential impact of drug metabolism on the treatment response of patients with pancreatic adenosquamous carcinoma is largely unknown.
CASE PRESENTATION
METHODS
We describe the case of a 51 year old woman with pancreatic adenosquamous carcinoma who, following surgical resection, experienced early disease relapse during adjuvant gemcitabine therapy. Paradoxically, this was followed by an exceptional response to capecitabine therapy lasting 34.6 months. Strong expression of cytidine deaminase was detected within the tumour.
CONCLUSIONS
CONCLUSIONS
This case study demonstrates that early relapse during adjuvant chemotherapy for pancreatic adenosquamous carcinoma may be compatible with a subsequent exceptional response to second line chemotherapy, an important observation given the poor overall prognosis of patients with adenosquamous carcinoma. Cytidine deaminase is predicted to inactivate gemcitabine and, conversely, catalyze capecitabine activation. We discuss strong intra-tumoural expression of cytidine deaminase as a potential mechanism to explain this patient's disparate responses to gemcitabine and capecitabine therapy, and highlight the benefit that may be gained from considering similar determinants of response to chemotherapy in clinical practice.
Identifiants
pubmed: 31941506
doi: 10.1186/s12885-020-6516-1
pii: 10.1186/s12885-020-6516-1
pmc: PMC6964020
doi:
Substances chimiques
Antimetabolites, Antineoplastic
0
Deoxycytidine
0W860991D6
Cytidine Deaminase
EC 3.5.4.5
Gemcitabine
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
38Subventions
Organisme : NCI NIH HHS
ID : P30 CA045508
Pays : United States
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