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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Spontaneous regression of pancreatic cancer with liver metastases
  1. Patricia Saade Lemus1,
  2. Kevin Anderson2,
  3. Martin Smith3 and
  4. Andrea Bullock1
  1. 1 Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2 Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Andrea Bullock, abullock{at}bidmc.harvard.edu

Abstract

Spontaneous cancer regression is a rare event, scarcely reported among gastrointestinal malignancies. Pancreatic adenocarcinoma regression has been documented in five previous cases, none of which included liver metastases, and the mechanism by which this occurs is not known. A 56-year-old woman with history of discoid lupus, homocysteinemia and peripheral vascular disease was diagnosed with stage IV pancreatic ductal adenocarcinoma (PDA) metastatic to the liver. She received palliative chemotherapy with 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) for 6 months, complicated by mucositis, diarrhoea, vomiting and two Clostridium difficile colitis episodes. Cancer initially responded to chemotherapy. However, due to substantial toxicities, she decided to discontinue cytotoxic chemotherapy and focus on palliation alone. Thereafter, CT and carbohydrate antigen (CA) 19-9 showed further response and ultimately complete cancer regression that has persisted for 33 months after cessation of chemotherapy. This is the first report in the English literature showing spontaneous regression of a PDA with liver metastases. Two possible mechanisms are proposed: antitumoral autoimmunity and tumour hypoxia related to vascular disease.

  • pancreatic cancer
  • carcinogenesis

https://doi.org/10.1136/bcr-2019-229619

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    Footnotes

    • Contributors PSL and AB made substantial contributions to the conception and design of the work, the acquisition, analysis or interpretation of data. They drafted the work and provided final approval of the version published. MS and KA made substantial contributions to the design of the work, the acquisition of data, and provided approval for the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.