Long-Term Response and Survival With Liposomal Irinotecan and Fluorouracil in a Patient With Locally Advanced Pancreatic Ductal Adenocarcinoma: A Case Report.

Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in the advanced stages. Despite available first-line systemic chemotherapies, prognosis for patients with PDAC remains poor. The combination of liposomal irinotecan plus fluorouracil (5-FU) and leucovorin (LV) is approved for the treatment of patients with metastatic PDAC who have previously progressed on gemcitabine-based chemotherapy. This case study reports on a 56-year-old female who was diagnosed with locally advanced stage III PDAC (T4, N2, M0). The tumor was judged inoperable by the multidisciplinary team (MDT), and the decision was taken to initiate systemic therapy. First-line modified FOLFIRINOX (fluorouracil (5-FU), leucovorin (LV), irinotecan, and oxaliplatin) was administered for 12 cycles, as per local standards, over six months and achieved a partial response (PR). Second-line gemcitabine monotherapy was initiated five months later (11 months after diagnosis) after computed tomographic (CT) imaging revealed new lesions in the interlobar pleura of the left lung. A best response of stable disease was achieved. Following disease progression, third-line liposomal irinotecan plus 5-FU was started 10 months after second-line treatment initiation (and 21 months after diagnosis). Best response was PR. Treatment continued until evidence of new lesions 35 months later (and 56 months after diagnosis). The patient was subsequently switched to fourth-line cisplatin/gemcitabine. All treatments were generally well tolerated. The patient demonstrated a good performance status throughout treatment. Remarkable findings of a sustained response for almost three years with third-line liposomal irinotecan plus 5-FU in our patient with locally advanced disease offer the potential for improving the current poor prognosis associated with PDAC.