Unexpected complete remission after recurrence in pancreatic cancer: a case report on comprehensive multimodal therapy

TL;DR

A pancreatic cancer patient achieved complete remission after recurrence through a combination of surgery and chemotherapy.

Contribution

This case report highlights the effectiveness of multimodal therapy in achieving remission in recurrent pancreatic cancer.

Findings

The patient remained tumor-free for 17 months after surgery and modified AG regimen chemotherapy.

Complete remission was achieved after six months of NALIRIFOX therapy following recurrence.

The case emphasizes the importance of vigilant surveillance and multimodal treatment in resectable PDAC.

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is among the most aggressive malignancies of the digestive tract, with a 5-year survival rate below 13%. It often infiltrates surrounding tissues early, making it challenging to distinguish primary pancreatic involvement from adjacent malignancies on imaging. Despite advancements in surgery, chemotherapy, and radiotherapy, PDAC still carries a high risk of recurrence. Here, we present a case initially diagnosed by imaging and biopsy as a duodenal malignancy. The patient underwent robotic-assisted laparoscopic pancreaticoduodenectomy, and final pathology confirmed moderately differentiated PDAC. Postoperative treatment with eight cycles of a modified AG (GN) regimen achieved 17 months of tumor-free survival. Following the detection of peritoneal metastases, the patient received six months of NALIRIFOX therapy and achieved complete remission by the ninth month after recurrence. This case underscores the critical role of surgery and adjuvant chemotherapy in resectable PDAC. It also highlights the importance of vigilant postoperative surveillance for early detection of recurrence and emphasizes the concept of pseudoprogression when interpreting imaging findings.

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