Metastatic ovarian tumor from pancreatic cancer treated with combined immunotherapy: A case report

Tao,Yiying; Tang,Lei; Zuo,Li; Ma,Yue; Zhang,Fengchun; Xu,Yingchun

doi:10.3892/ol.2022.13464

Metastatic ovarian tumor from pancreatic cancer treated with combined immunotherapy: A case report

Authors:
- Yiying Tao
- Lei Tang
- Li Zuo
- Yue Ma
- Fengchun Zhang
- Yingchun Xu
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Affiliations: Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China, Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu 215000, P.R. China, Department of Oncology, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 201100, P.R. China
Published online on: August 17, 2022 https://doi.org/10.3892/ol.2022.13464
Article Number: 344
Copyright: © Tao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Pancreatic cancer (PC) is a fatal disease with a high mortality rate due to difficulties in early diagnosis and metastasis. Common sites of metastasis from PC include the liver, lung, stomach and kidney. Patients diagnosed at already the metastatic stages on presentation constitute 50‑55% of the cases, with a 5‑year survival rate of 3%. By contrast, secondary ovarian metastases account for 10‑25% of all ovarian malignancies, though an accurate diagnosis remain challenging. The present study reports the rare case of a 42‑year‑old woman with primary hepatic metastasis and secondary ovarian metastasis from PC treated with two lines of immunotherapy, who is also experiencing severe treatment‑associated toxicity. The patient first received combined immunotherapy consisting of camrelizumab (200 mg; day 1; every 3 weeks) and chemotherapy with nab‑paclitaxel (125 mg/m²; days 1 and 8; every 3 weeks) and gemcitabine (1,000 mg/m²; days 1 and 8; every 3 weeks). She then exhibited a partial response following 4 months of treatment. However, 9 months after the initial treatment, the disease progressed with ovarian involvement, which was confirmed by surgery. Second‑line treatment included immunotherapy, targeted therapy and oral chemotherapy (200 mg sintilimab on day 1; 50 mg tegafur from days 1‑14, twice daily; and 8 mg anlotinib from days 1‑14, every 3 weeks). The progression‑free survival time from this second‑line treatment was 6 months. Immunotherapy was permanently aborted due to severe intestinal inflammation, where four lines of combined treatments were recommended. The patient remains on treatment with a good quality of life in July 2022, and a current overall survival time of >24 months. In conclusion, the diagnosis of metastatic PC leads to a poor prognosis, but ovarian metastasis from PC is rare. Furthermore, the combination of immunotherapy with chemotherapy or antiangiogenic inhibitors shows promise as a treatment strategy for advanced stages of PC.

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1	Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021. View Article : Google Scholar : PubMed/NCBI
2	Yang J, Xu R, Wang C, Qiu J, Ren B and You L: Early screening and diagnosis strategies of pancreatic cancer: A comprehensive review. Cancer Commun (Lond). 41:1257–1274. 2021. View Article : Google Scholar : PubMed/NCBI
3	Park W, Chawla A and O'Reilly EM: Pancreatic cancer: A review. JAMA. 326:851–862. 2021. View Article : Google Scholar : PubMed/NCBI
4	Vincent A, Herman J, Schulick R, Hruban RH and Goggins M: Pancreatic cancer. Lancet. 378:607–620. 2011. View Article : Google Scholar : PubMed/NCBI
5	Habib JR, Pasha S, Khan S, Kinny-Köster B, Shoucair S, Thompson ED, Yu J, Lafaro K, Burkhart RA, Burns WR, et al: Ovarian metastasis from pancreatic ductal adenocarcinoma. World J Surg. 45:3157–3164. 2021. View Article : Google Scholar : PubMed/NCBI
6	Jin T, Dai C and Xu F: Surgical and local treatment of hepatic metastasis in pancreatic ductal adenocarcinoma: Recent advances and future prospects. Ther Adv Med Oncol. Jun 23–2020.(Epub ahead of print). View Article : Google Scholar
7	Shah A, Korrapati P, Siegel J and Kasmin F: Rare metastasis of primary pancreatic adenocarcinoma to the bladder. ACG Case Rep J. 5:e272018. View Article : Google Scholar : PubMed/NCBI
8	de Waal YR, Thomas CM, Oei AL, Sweep FC and Massuger LF: Secondary ovarian malignancies: Frequency, origin, and characteristics. Int J Gynecol Cancer. 19:1160–1165. 2009. View Article : Google Scholar : PubMed/NCBI
9	Chun YS, Pawlik TM and Vauthey JN: 8th edition of the AJCC cancer staging manual: Pancreas and hepatobiliary cancers. Ann Surg Oncol. 25:845–847. 2018. View Article : Google Scholar : PubMed/NCBI
10	Schwartz LH, Seymour L, Litière S, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J, et al: RECIST 1.1-standardisation and disease-specific adaptations: Perspectives from the RECIST working group. Eur J Cancer. 62:138–145. 2016. View Article : Google Scholar : PubMed/NCBI
11	U.S. Department of Health and Human Services; National Institutes of Health and the National Cancer Institute, : Commn Terminology Criteria for Adverse Events (CTCAE). V4.03. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAE_4.03_2010-06-14_QuickReference_5×7.pdfMay 17–2010
12	Siegel RL, Miller KD, Fuchs HE and Jemal A: Cancer statistics, 2022. CA Cancer J Clin. 72:7–33. 2022. View Article : Google Scholar : PubMed/NCBI
13	Chu LC, Goggins MG and Fishman EK: Diagnosis and detection of pancreatic cancer. Cancer J. 23:333–342. 2017. View Article : Google Scholar : PubMed/NCBI
14	Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET and Carbone PP: Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 5:649–655. 1982. View Article : Google Scholar : PubMed/NCBI
15	Gourgou-Bourgade S, Bascoul-Mollevi C, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Boige V, et al: Impact of FOLFIRINOX compared with gemcitabine on quality of life in patients with metastatic pancreatic cancer: Results from the PRODIGE 4/ACCORD 11 randomized trial. J Clin Oncol. 31:23–29. 2013. View Article : Google Scholar : PubMed/NCBI
16	Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, et al: Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 369:1691–1703. 2013. View Article : Google Scholar : PubMed/NCBI
17	Christenson ES, Jaffee E and Azad NS: Current and emerging therapies for patients with advanced pancreatic ductal adenocarcinoma: A bright future. Lancet Oncol. 21:e135–e145. 2020. View Article : Google Scholar : PubMed/NCBI
18	Patnaik A, Kang SP, Rasco D, Papadopoulos KP, Elassaiss-Schaap J, Beeram M, Drengler R, Chen C, Smith L, Espino G, et al: Phase I study of pembrolizumab (MK-3475; Anti-PD-1 monoclonal antibody) in patients with advanced solid tumors. Clin Cancer Res. 21:4286–4293. 2015. View Article : Google Scholar : PubMed/NCBI
19	Marabelle A, Le DT, Ascierto PA, Di Giacomo AM, De Jesus-Acosta A, Delord JP, Geva R, Gottfried M, Penel N, Hansen AR, et al: Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: Results from the phase II KEYNOTE-158 study. J Clin Oncol. 38:31–10. 2020. View Article : Google Scholar
20	Marabelle A, Fakih M, Lopez J, Shah M, Shapira-Frommer R, Nakagawa K, Chung HC, Kindler HL, Lopez-Martin JA, Miller WH Jr, et al: Association of tumour mutational burden with outcomes in patients with advanced solid tumours treated with pembrolizumab: Prospective biomarker analysis of the multicohort, open-label, phase 2 KEYNOTE-158 study. Lancet Oncol. 21:1353–1365. 2020. View Article : Google Scholar : PubMed/NCBI
21	Tempero MA: NCCN guidelines updates: Pancreatic cancer. J Natl Compr Canc Netw. 17:603–605. 2019.PubMed/NCBI
22	Markham A and Keam SJ: Camrelizumab: First global approval. Drugs. 79:1355–1361. 2019. View Article : Google Scholar : PubMed/NCBI
23	Padrón LJ, Maurer DM, O'Hara MH, O'Reilly EM, Wolff RA, Wainberg ZA, Ko AH, Fisher G, Rahma O, Lyman JP, et al: Sotigalimab and/or nivolumab with chemotherapy in first-line metastatic pancreatic cancer: Clinical and immunologic analyses from the randomized phase 2 PRINCE trial. Nat Med. 28:1167–1177. 2022. View Article : Google Scholar : PubMed/NCBI
24	Tempero M, Oh DY, Tabernero J, Reni M, Van Cutsem E, Hendifar A, Waldschmidt DT, Starling N, Bachet JB, Chang HM, et al: Ibrutinib in combination with nab-paclitaxel and gemcitabine for first-line treatment of patients with metastatic pancreatic adenocarcinoma: Phase III RESOLVE study. Ann Oncol. 32:600–608. 2021. View Article : Google Scholar : PubMed/NCBI
25	Kubeček O, Laco J, Špaček J, Petera J, Kopecký J, Kubečková A and Filip S: The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: A comprehensive review. Clin Exp Metastasis. 34:295–307. 2017. View Article : Google Scholar : PubMed/NCBI
26	Al-Agha OM and Nicastri AD: An in-depth look at krukenberg tumor: An overview. Arch Pathol Lab Med. 130:1725–1730. 2006. View Article : Google Scholar : PubMed/NCBI
27	Yamanishi Y, Koshiyama M, Ohnaka M, Ueda M, Ukita S, Hishikawa K, Nagura M, Kim T, Hirose M, Ozasa H and Shirase T: Pathways of metastases from primary organs to the ovaries. Obstet Gynecol Int. 2011:6128172011. View Article : Google Scholar : PubMed/NCBI
28	Prat J: Ovarian carcinomas, including secondary tumors: Diagnostically challenging areas. Mod Pathol. 18 (Suppl 2):S99–S111. 2005. View Article : Google Scholar : PubMed/NCBI
29	Sodek KL, Murphy KJ, Brown TJ and Ringuette MJ: Cell-cell and cell-matrix dynamics in intraperitoneal cancer metastasis. Cancer Metastasis Rev. 31:397–414. 2012. View Article : Google Scholar : PubMed/NCBI
30	Taylor EC, Irshaid L and Mathur M: Multimodality imaging approach to ovarian neoplasms with pathologic correlation. Radiographics. 41:289–315. 2021. View Article : Google Scholar : PubMed/NCBI
31	Ansari D, Rosendahl A, Elebro J and Andersson R: Systematic review of immunohistochemical biomarkers to identify prognostic subgroups of patients with pancreatic cancer. Br J Surg. 98:1041–1055. 2011. View Article : Google Scholar : PubMed/NCBI
32	Nath S, Daneshvar K, Roy LD, Grover P, Kidiyoor A, Mosley L, Sahraei M and Mukherjee P: MUC1 induces drug resistance in pancreatic cancer cells via upregulation of multidrug resistance genes. Oncogenesis. 2:e512013. View Article : Google Scholar : PubMed/NCBI
33	Park JH and Kim JH: Pathologic differential diagnosis of metastatic carcinoma in the liver. Clin Mol Hepatol. 25:12–20. 2019. View Article : Google Scholar : PubMed/NCBI
34	Dabir PD, Svanholm H and Christiansen JJ: SATB2 is a supplementary immunohistochemical marker to CDX2 in the diagnosis of colorectal carcinoma metastasis in an unknown primary. APMIS. 126:494–500. 2018. View Article : Google Scholar : PubMed/NCBI