Pathologic Complete Response to Modified FOLFIRINOX Enabling Conversion Surgery in Pancreatic Acinar Cell Carcinoma on Hemodialysis: A Case Report.

INTRODUCTION: With recent advances in systemic chemotherapy for pancreatic cancer, a subset of patients with initially unresectable disease, particularly those who respond favorably to treatment, can now undergo conversion surgery (CS) and achieve prolonged survival. However, in patients undergoing hemodialysis (HD), optimal chemotherapy dosing and dialysis scheduling have not been established, raising concerns about increased chemotherapy-related toxicity and uncertain antitumor efficacy. Here, we report a case in which chemotherapy was successfully administered to a HD patient with unresectable locally advanced pancreatic cancer.

CASE PRESENTATION: A 48-year-old male on maintenance HD was diagnosed with pancreatic head cancer, pathologically confirmed as acinar cell carcinoma (ACC). The tumor showed a 270° involvement of the superior mesenteric vein and a 200° contact with the superior mesenteric artery. The patient received 19 cycles of modified FOLFIRINOX (mFFX) with a uniform 40% dose reduction under an adjusted dialysis schedule. The primary tumor decreased in size, achieving a partial response according to Response Evaluation Criteria In Solid Tumors (RECIST). Subsequently, the patient underwent pancreaticoduodenectomy with portal vein resection. Pathological examination revealed a pathological complete response. No adjuvant chemotherapy was administered, and no recurrence has been observed during 3 years of postoperative follow-up.

CONCLUSIONS: We successfully administered prolonged mFFX in a dialysis patient with unresectable pancreatic head ACC, enabling CS with curative intent. This case suggests that carefully dose-adjusted mFFX with appropriate dialysis scheduling can be a feasible and effective treatment option for selected HD patients with unresectable pancreatic cancer.