Cancer Res Treat.  2017 Jul;49(3):759-765. 10.4143/crt.2016.371.

Efficacy of Chemotherapy in Patients with Unresectable or Metastatic Pancreatic Acinar Cell Carcinoma: Potentially Improved Efficacy with Oxaliplatin-Containing Regimen

Affiliations
  • 1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. changhm@amc.seoul.kr
  • 2Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Pancreatic acinar cell carcinoma (ACC) is a rare cancer of the exocrine pancreas. Because of its rare incidence, the efficacy of chemotherapy in this patient population has been largely unknown. Therefore, we retrospectively analyzed the outcomes of patients with advanced pancreatic ACC who received chemotherapy.
MATERIALS AND METHODS
Between January 1997 and March 2015, 15 patients with unresectable or metastatic pancreatic ACC who received systemic chemotherapy were identified in Asan Medical Center, Korea.
RESULTS
The median age was 58 years. Eleven and four patients had recurrent/metastatic and locally advanced unresectable disease. The median overall survival in all patients was 20.9 months (95% confidence interval [CI], 15.7 to 26.1). As first-line therapy, intravenous 5-fluorouracil were administered in four patients (27%), gemcitabine in five (33%), gemcitabine plus capecitabine in two (13%), oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX) in two (13%), and concurrent chemoradiotherapy followed by capecitabine maintenance therapy in two (13%). The objective response rate (ORR) to chemotherapy alone was 23% and the median progression-free survival (PFS) was 5.6 months (95% CI, 2.8 to 8.4). After progression, second-line chemotherapy was administered in eight patients, while four patients received FOLFOX and the other four patients received gemcitabine. The ORR was 38%, and patients administered FOLFOX had significantly better PFS than those administered gemcitabine (median, 6.5 months vs. 1.4 months; p=0.007). The ratio of time to tumor progression (TTP) during first-line chemotherapy to TTP at second-line chemotherapy was significantly higher in patients administered FOLFOX (4.07; range, 0.87 to 8.30) than in those administered gemcitabine (0.12; range, 0.08 to 0.25; p=0.029).
CONCLUSION
Our results suggest that oxaliplatin-containing regimens may have improved activity against pancreatic ACC.

Keyword

Acinar cell carcinoma; Pancreatic neoplasms; Antineoplastic agents; Oxaliplatin

MeSH Terms

Acinar Cells*
Antineoplastic Agents
Capecitabine
Carcinoma, Acinar Cell*
Chemoradiotherapy
Chungcheongnam-do
Disease-Free Survival
Drug Therapy*
Fluorouracil
Humans
Incidence
Korea
Pancreas, Exocrine
Pancreatic Neoplasms
Retrospective Studies
Antineoplastic Agents
Capecitabine
Fluorouracil

Figure

  • Fig. 1. Progression-free survival with first-line chemotherapy of patients with chemotherapy alone (A) and overall survival of all patients (B). CI, confidence interval.

  • Fig. 2. Progression-free survival with second-line chemotherapy. CI, confidence interval; FOLFOX, oxaliplatin plus 5-fluorouracil/leucovorin; GEM, gemcitabine.


Reference

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