GemOx and Ovarian Pancreatic Cancer Metastasis (PC)

Context We report a case of clinical benefit and RP with GemOx in patient with cystadenocarcinoma of pancreas with ovarian metastasis. Case report In July 2008 a 42-year-old woman complained of abdominal pain and constipation. The CT scan and the MR showed the presence of two bilateral ovarian mass with pancreatic extension. The patient arrived then to our hospital and ECOG PS was 2. She underwent bilateral ovarian and womb resection. During surgery peritoneal carcinosis, a pancreatic mass and multiple abdominal lesions were found. Multiple biopsies of pancreatic lesion and other abdominal lesions documented mucinous cystadenocarcinoma of pancreas, with ovarian and peritoneal metastases. In December 2008 the patient started chemotherapy (CHT) with gemcitabine 1000 mg/m2/dL and oxaliplatin 100 mg/m2/d2 every 2 weeks (GemOx). After 6 cycles of CHT a CT scan showed a stable disease. Clinical conditions were good (ECOG 0) so we decided to continue the medical treatment with other 6 cycles of CHT. In August 2009 a CT scan showed a reduction of the abdominal mass, and a surgical resection was then possible. The patient underwent distal pancreatic resection, regional lymphadenectomy and splenectomy. Pathologic examination documented biliopancreatic well differentiated adenocarcinoma. Surgical margins presented malignant cells and mucoid areas without cells. After surgery we decided to continue CHT with gemcitabine as "adjuvant treatment" for other 3 cycles, CT scan showed no disease, clinical conditions were good and the patient stopped the treatment. Actually there is no evidence or relapse. Conclusion As reported in literature, GemOx is associated with improvement in PFS and clinical benefit in patient with advanced pancreatic cancer. This is an interesting case where GemOx leaded inoperable pancreatic cancer to a operable cancer.