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<p>Nanoliposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (5-FU/LV) has become an established regimen for pancreatic ductal adenocarcinoma (PDAC) after gemcitabine-based therapy; however, complete response remains exceptionally rare. Here, we describe a 70-year-old female patient under surveillance for branch-duct intraductal papillary mucinous neoplasm who developed a new hypovascular pancreatic head mass (~ 30&#xa0;mm) with &gt; 180° contact to the portal vein, consistent with borderline resectable PDAC. Adenocarcinoma was confirmed by endoscopic ultrasound-guided tissue acquisition. Initial therapy comprised gemcitabine plus nab-paclitaxel, but the patient showed radiographic and biochemical progression. Modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin (LV), and 5-fluorouracil (5-FU)) was attempted as second-line therapy, but discontinued after one cycle due to Grade 3 myelosuppression and severe fatigue. Subsequently, nal-IRI + 5-FU/LV was administered as third-line therapy for 10 cycles and toxicity was manageable. Follow-up contrast-enhanced computed tomography revealed marked tumor regression and resolution of previously observed right lower-lobe pulmonary opacity. Following multidisciplinary reassessment and with informed consent, subtotal stomach-preserving pancreaticoduodenectomy was performed. The resected specimen showed a 13&#xa0;mm fibrotic scar without residual viable carcinoma and no lymph node metastasis was identified, meeting criteria for pathological complete response. At 25-month follow-up, the patient remained disease-free. This case provides evidence that nal-IRI + 5-FU/LV may induce profound tumor regression in carefully selected patients with preserved performance status and favorable baseline factors, enabling potentially curative resection after failure or intolerance to standard first-line regimens.</p>

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Pathological complete response after nanoliposomal irinotecan plus fluorouracil/leucovorin and conversion surgery in borderline resectable pancreatic head adenocarcinoma: a case report

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Kazunori Nakaoka,
  • Aki Nishijima,
  • Yuki Asai,
  • Gakushi Koumura,
  • Madoka Isomura,
  • Yuichiro Uchida,
  • Hiroyuki Tanaka,
  • Takuji Nakano,
  • Sayaka Ueno,
  • Teiji Kuzuya,
  • Takeshi Takahara,
  • Tamotsu Sudo,
  • Sachiko Minamiguchi,
  • Yoshiki Hirooka,
  • Eizaburo Ohno

摘要

Nanoliposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (5-FU/LV) has become an established regimen for pancreatic ductal adenocarcinoma (PDAC) after gemcitabine-based therapy; however, complete response remains exceptionally rare. Here, we describe a 70-year-old female patient under surveillance for branch-duct intraductal papillary mucinous neoplasm who developed a new hypovascular pancreatic head mass (~ 30 mm) with > 180° contact to the portal vein, consistent with borderline resectable PDAC. Adenocarcinoma was confirmed by endoscopic ultrasound-guided tissue acquisition. Initial therapy comprised gemcitabine plus nab-paclitaxel, but the patient showed radiographic and biochemical progression. Modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin (LV), and 5-fluorouracil (5-FU)) was attempted as second-line therapy, but discontinued after one cycle due to Grade 3 myelosuppression and severe fatigue. Subsequently, nal-IRI + 5-FU/LV was administered as third-line therapy for 10 cycles and toxicity was manageable. Follow-up contrast-enhanced computed tomography revealed marked tumor regression and resolution of previously observed right lower-lobe pulmonary opacity. Following multidisciplinary reassessment and with informed consent, subtotal stomach-preserving pancreaticoduodenectomy was performed. The resected specimen showed a 13 mm fibrotic scar without residual viable carcinoma and no lymph node metastasis was identified, meeting criteria for pathological complete response. At 25-month follow-up, the patient remained disease-free. This case provides evidence that nal-IRI + 5-FU/LV may induce profound tumor regression in carefully selected patients with preserved performance status and favorable baseline factors, enabling potentially curative resection after failure or intolerance to standard first-line regimens.