Gemox in combination witherlotinib (E) in pancreatic cancer (PC).

Context: We report a case of clinical benefit and metabolic response to GEMOX and E. Case report: In November 2007 a 48-year-old woman was admitted to the our Oncology Unit for a suspected PC with a doubtful lung lesion on the basis of a CT carried out following the appearance of the abdominal pain and alteration of CA19.9 (1719 U/mL). A biopsy of pancreatic lesion documented an infiltrating pancreatic ductal adenocarcinoma. In December patient underwent exploratory laparotomy but due to the infiltration of the main vascular structures only a diagnostic laparotomy was possible. The clinical conditions were compromised (ECOG 2). CA19.9 was 21.890 U/mL. The patient started on a chemotherapy (CHT) with gemcitabine 1000 mg/m2/d1 and oxaliplatin 100 mg/m2/d2 every 2 weeks (GEMOX). After 3 cycles of CHT a CT showed a reduction in size of the pancreatic lesion (4.4 x 3.3 cm to 2.8 x 2.6 cm), a doubtful liver lesion, a stable lung lesion and multiple bone thickening lesions. CA19.9 was 8,942 U/mL. In February a PET showed a hyperfixation of tracer in pancreatic head, left lung and at the level of multiple segments of bone compatible with secondary lesions. The clinical conditions worsened. Therefore patient started on GEMOX combined with E 100 mg daily and also Zoledronic acid. After 6 cycles of CHT, a CT showed an important reduction of the lung lesion, compatible with a primary neoplasm; the bone lesions were stable and the pancreatic lesion was further reduced. A subsequent PET showed a minimal residual disease at the bone level only. The clinical conditions improved significantly (ECOG 0). CA 19.9 was 1382 U/mL. Conclusion: This is the first case reported in literature in which was used the combination of GEMOX and E.