FOLFIRINOX is a highly effective anticancer treatment, even in advanced pancreatic cancer, which provides a potential cure in patients initially treated with a palliative strategy. A 47-year-old man was found to have an unresectable pancreatic cancer (4 cm in size) surrounding both the superior mesenteric artery and superior mesenteric vein. A simultaneous liver metastasis in Segment 8, with a diameter of 17 mm, was also detected. The pancreatic tumor markers CEA, CA19-9, and DUPAN-2 were significantly elevated to 21.7 ng/mL, 6224 ng/mL, and 1200U/mL, respectively. After 21 courses of FOLFIRINOX, the primary pancreatic tumor diminished in size (partial response) from 42 to 17 mm, and the liver mass almost disappeared. The tumor markers significantly decreased to almost normal levels. Fourteen months after the initial chemotherapy, conversion surgery was performed. Upon surgical resection, the pancreatic tumor was found to be Grade 1b, and a pathologically complete response was observed for the liver metastasis. The patient is still alive 32 months after initial treatment with no recurrence. This is an informative case of a locally advanced pancreatic cancer with a synchronous liver metastasis that had a significant response to FOLFIRINOX, allowing for subsequent curative resection.
Pancreatic cancer Conversion surgery FOLFIRINOX
Multi-detector computed tomography
Positron emission tomography–computed tomography
Uridine diphosphate glucuronosyltransferase
This is a preview of subscription content, log in to check access.
KO, HH, YI, SA, and HT performed the operation. HH and HT determined the treatment plan. HB and TK provided critical review of clinical findings. All other authors made a round of visits after the operation. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest concerning this article.
Human and animal rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images.
Informed consent was obtained for this case report.
Hidalgo M, Cascinu S, Kleeff J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15:8–18.CrossRefGoogle Scholar
Cid-Arregui A, Juarez V. Perspectives in the treatment of pancreatic adenocarcinoma. World J Gastroenterol. 2015;21:9297–316.CrossRefGoogle Scholar
Garrido-Laguna I, Hidalgo M. Pancreatic cancer: from state-of-the-art treatments to promising novel therapies. Nat Rev Clin Oncol. 2015;12:319–34.CrossRefGoogle Scholar
Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.CrossRefGoogle Scholar
Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. Jama. 2013;310:1473–81.CrossRefGoogle Scholar
Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.CrossRefGoogle Scholar
Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.CrossRefGoogle Scholar
Conroy T, Paillot B, Francois E, et al. Irinotecan plus oxaliplatin and leucovorin-modulated fluorouracil in advanced pancreatic cancer–a Groupe Tumeurs Digestives of the Federation Nationale des Centres de Lutte Contre le Cancer study. J Cli Oncol. 2005;23:1228–36.CrossRefGoogle Scholar
Evans DB, Rich TA, Byrd DR, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.CrossRefGoogle Scholar
Buc E, Orry D, Antomarchi O, et al. Resection of pancreatic ductal adenocarcinoma with synchronous distant metastasis: is it worthwhile? World J Surg Oncol. 2014;12:347.CrossRefGoogle Scholar
Schneitler S, Kropil P, Riemer J, et al. Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection. World J Gastroenterol. 2015;21:6384–90.CrossRefGoogle Scholar
Sasaki T, Isayama H, Aoki T, et al. A R0 resection case of initially unresectable metastatic pancreatic cancer downstaged by FOLFIRINOX therapy. Pancreas. 2014;43:972–4.CrossRefGoogle Scholar
Neofytou K, Giakoustidis A, Smyth EC, et al. A case of metastatic pancreatic adenocarcinoma with prolonged survival after combination of neoadjuvant FOLFIRINOX therapy and synchronous distal pancreatectomy and hepatectomy. J Surg Oncol. 2015;111:768–70.CrossRefGoogle Scholar
Crippa S, Bittoni A, Sebastiani E, et al. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol. 2016;42:1533–9.CrossRefGoogle Scholar
Donahue TR, Isacoff WH, Hines OJ, et al. Downstaging chemotherapy and alteration in the classic computed tomography/magnetic resonance imaging signs of vascular involvement in patients with pancreaticobiliary malignant tumors: influence on patient selection for surgery. Arch Surg. 2011;146:836–43.CrossRefGoogle Scholar
Hashemi-Sadraei N, Gbolahan OB, Salfity H, et al. Clinical characteristics of patients experiencing pathologic complete response following neoadjuvant therapy for borderline resectable/locally advanced pancreatic adenocarcinoma. Am J Clin Oncol. 2018;41:982–5.CrossRefGoogle Scholar
Shimada K, Kosuge T, Yamamoto J, et al. Successful outcome after resection of pancreatic cancer with a solitary hepatic metastasis. Hepato-gastroenterology. 2004;51:603–5.Google Scholar
Spinelli GP, Zullo A, Romiti A, et al. Long-term survival in metastatic pancreatic cancer. A case report and review of the literature. JOP Journal Pancreas. 2006;7:486–91.Google Scholar
Ibusuki M, Hiraoka T, Kanemitsu K, et al. Complete remission of pancreatic cancer after multiple resections of locally pancreatic recurrent sites and liver metastasis: report of a case. Surg Today. 2008;38:563–6.CrossRefGoogle Scholar
Klein F, Puhl G, Guckelberger O, et al. The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract. 2012;2012:939350.CrossRefGoogle Scholar
Satoi S, Yamaue H, Kato K, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepato-Biliary-Pancreat Sci. 2013;20:590–600.CrossRefGoogle Scholar
Luu AM, Herzog T, Hoehn P, et al. FOLFIRINOX treatment leading to pathologic complete response of a locally advanced pancreatic cancer. J Gastrointest Oncol. 2018;9:E9–12.CrossRefGoogle Scholar
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.CrossRefGoogle Scholar
Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. Jama. 2010;304:1073–81.CrossRefGoogle Scholar
Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011–24.CrossRefGoogle Scholar
Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.CrossRefGoogle Scholar
Ariake K, Motoi F, Mizuma M, et al. Locally advanced pancreatic cancer successfully treated by distal pancreatectomy with celiac axis resection (DP-CAR) after S-1 with radiation therapy followed by gemcitabine/nab-paclitaxel therapy: a case report. Surg Case Rep. 2017;3:15.CrossRefGoogle Scholar
Shimura M, Mizuma M, Hayashi H, et al. A long-term survival case treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis. Surg Case Rep. 2017;3:132.CrossRefGoogle Scholar