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Case Reports
. 2023 Feb 6;16(2):e251936.
doi: 10.1136/bcr-2022-251936.

Partial response in non-resectable adenosquamous carcinoma of the pancreas with high tumour mutation burden treated with gemcitabine, nab-paclitaxel and pembrolizumab

Rodrigo Paredes de la Fuente  1 , James W Doolin  1 , Mary Linton Peters  2
Affiliations
Case Reports

Partial response in non-resectable adenosquamous carcinoma of the pancreas with high tumour mutation burden treated with gemcitabine, nab-paclitaxel and pembrolizumab

Rodrigo Paredes de la Fuente et al. BMJ Case Rep. .

Abstract

A previously healthy man in his 60s was diagnosed with a rare histological subtype of pancreatic cancer, adenosquamous carcinoma. After somatic mutation profiling, it was found that the tumour had microsatellite instability status high and a high tumour mutational burden. The patient was started on combination therapy with gemcitabine, nab-paclitaxel and pembrolizumab. Tumour size and biomarkers showed a dramatic response eventually leading to the patient being transitioned to maintenance therapy with pembrolizumab. The patient has demonstrated continued response since the start of the treatment. This is the first report in the literature showing a sustained response in this type of neoplasm that was treated with a checkpoint inhibitor, and thus adds to the evidence supporting universal somatic testing in all pancreatic cancers for a tailored approach to therapy.

Keywords: Chemotherapy; Pancreatic cancer.

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Conflict of interest statement

Competing interests: MLP—none related to the submitted work; outside the submitted work, institutional research funding from Nucana, Taiho Oncology, Merck, BeiGene and Berg.

Figures

Figure 1
Figure 1
CT showing hypoattenuating heterogeneous mass in the pancreatic body and tail that measures 10.2×4.4×4.7 cm that encase the coeliac axis and the common hepatic artery, as well as the main portal vein.
Figure 2
Figure 2
Trend in carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) biomarker in accordance with therapeutic changes. ASCP, adenosquamous carcinoma of the pancreas; FOLFIRINOX, leucovorin, 5-fluorouracil, irinotecan and oxaliplatin.
Figure 3
Figure 3
CT of the abdomen showing hypoattenuating mass measuring 6.1×1.9 cm that continues to decrease in size after several weeks of pembrolizumab maintenance therapy.
See this image and copyright information in PMC

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