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Case Histories

Patient's Survival Serves as Testimony to Tolerability and Efficacy of Alternative Cancer Therapy Treatment

Metastatic pancreatic cancer with comorbidities. Less toxic regimen as the patient has been tolerating it for over two years.

Patient History

68-year-old Russian male with multiple comorbidities including hypertension diabetes, coronary artery disease, and hypercholesterolemia who was diagnosed with stage IV pancreatic cancer with multiple metastases to the liver in July of 2008.

Patient Diagnosis

  • The CAT scan showed dilated pancreatic duct with a large heterogeneous centrally low attenuating mass in the pancreatic head and uncinate process measuring 4.8 x 4.5 cm the large mass contacts the duodenum with findings worrisome for duodenal invasion there is also wall thickening of the third fourth portion of the duodenum.
  • Peripancreatic and celiac axis lymph nodes are present.
  • Also present are low attenuation lesions in the liver suspicious for hepatic metastases.
  • PET scan showed intense FDG uptake associated with the pancreatic mass. There is focal intense tracer uptake corresponding to the lesion in the right lobe of the liver and also intense uptake associated with the left lobe hypodensity.
  • The patient's CA-19-9 was elevated as well as the CEA.

Patient Challenge

The poor survival in patients with metastatic pancreatic cancer is well known. Patient's with metastatic pancreatic cancer receiving first-line therapy has been consistently reported in the range of 3 to 6 months on clinical trials. Of note randomized clinical trials tend to take the patient's with the best performance status.

Clinical Treatment Plan

The poor results with standard chemotherapy have been the impetus to innovate better treatments for these types of cancers. We utilized combination chemotherapy in low doses to more effectively treat pancreatic cancer and the other cancers that don't respond well to standard chemotherapy regimens.

We incorporated multiple drugs simultaneously to target multiple pathways simultaneously as well as maximizing the potential synergistic drug pairs in order to provide more effective therapy with less toxicity. The rationale is that by utilizing low doses we can combine more drugs, keep the toxicity profile low, treat for a longer period of time, and treat patient's who can otherwise not tolerate higher dose therapy.

Outcomes/Results

The patient was started on low-dose multidrug chemotherapy with GFLIOX in July of 2008 after 3 months his tumor markers had normalized. A repeat CAT scan done in November of 2008 showed a markedly reduced size of the pancreatic head mass now somewhat ill defined measuring approximately 1.8 cm in maximum dimension previously measuring 4.8 cm in maximum dimension.

The liver metastases have also reduced in size significantly. A PET scan performed in January of 2009 showed markedly decreased FDG activity in size of the previously described pancreatic mass suggestive of response to treatment with minimal residual active disease in addition markedly decreased FDG activity in the metastatic foci in the left lobe of the liver and the right lobe of the liver.

MRI performed in July of 2009 showed residual necrotic pancreatic tissue in the region of the previously seen pancreatic mass. No significant peri-pancreatic or celiac axis lymph nodes identified. The liver is normal without evidence for focal liver lesion. Follow-up MRIs continue to be negative the most recent one on 01/23/11.