What is the treatment for adenocarcinoma?

Hi,

Welcome to icliniq.com.

I can understand your concern.

An ultrasound revealed a mass in the head of the pancreas with borderline hepatomegaly and a dilated portal vein. The portal vein had extensive thrombosis. The omentum was thickened. A follow-up CT (computed tomography) scan confirmed a 4.4 x 4.8 x 5.4-centimeter mass in the head and uncinate process of the pancreas with thrombosis of distal SMV the main portal vein and splenic vein. There was a concern for infiltration of the second portion of the duodenum and regional adenopathy. A left adrenal gland mass was noted. An EUS was performed with an EUS-guided biopsy. This demonstrated well to moderately differentiated malignancy consistent with an adenocarcinoma. Immunohistochemistry is positive for CK19 S100 and CDX2. An FDG PET-CT scan was FDG avid at the pancreatic mass and in several of the lymph nodes. The left adrenal gland also had FDG uptake. Multiple subcentimeter pulmonary nodules were below the level of characterization by FDG PET-CT scan. A PDL1 assay had a CPS score of 15 with a TPS score of 3. Next-generation sequencing by FoundationOne performed later in June showed KRAS G12V, SMAD4, and TP53 mutations. Note however that the report indicates that there was low tumor purity and that ERBB2 and other genomic alterations may not have been identified. Microsatellite status and TMB (tumor mutational genome) could not be measured. GATA6, an assay under study for separating basal from classical pancreatic cancer was not performed.

It was elected to begin therapy with Gemcitabine and Nab-Paclitaxel. 8 cycles were given. The morphologic and metabolic response was confirmed by FDG PET-CT scan. The second FDG PET-CT scan showed a continued decrease in size and metabolic activity of the primary tumor but with a possible fistulous communication between the pancreas and the duodenum. A plasma CT DNA (computed tomography - deoxyribonucleic acid) showed no pathogenic mutations. Regarding possible future therapy with Fluorouracil-based treatment, the DPD assay was wild-type. The virtual consultation indicated that the patient tolerated Gemcitabine, and Abraxane reasonably and was able to continue her usual adult daily activities. It was elected to change therapy to single agent Capecitabine taking a total dose of 2 grams per day.

Note that the CA 19.9 was not elevated at diagnosis. The review of systems suggests that the patient is asymptomatic at this time, and at the virtual consultation was indicated that although she has not regained lost weight, her symptoms are otherwise reasonably well controlled.

I hope this information will help you.

Thanks.