Exceptional long-term survival in a patient with recurrent pancreatic carcinoma on adjuvant tegafur-gimeracil-oteracil potassium: a case report.

BACKGROUND: Pancreatic carcinoma is a highly malignant tumor, and it is aggressive even in its early stage. It has a very poor prognosis and responds poorly to systemic therapy. It is common for resected patients to undergo postoperative adjuvant chemotherapy. However, survival remains low, with an average 5-year survival of 10-25% and median survival between 10 and 20 months.

CASE PRESENTATION: A 50-year-old Malaysian Chinese gentleman with no past medical history was diagnosed with stage IIb pancreatic cancer. A computed tomography scan of the abdomen showed a tumor at the uncinate lobe of the pancreatic head. He underwent a Whipple pancreaticoduodenectomy followed by postoperative chemotherapy with gemcitabine combined with 5-fluorouracil for 6 months. However, a rising carbohydrate antigen 19-9 level and a positron emission tomography-computed tomography scan showing a 18F-fluorodeoxyglucose avid focus above the resected pancreas led to a repeat laparotomy 10 months after the first surgery. Even though an omental tissue biopsy at the area of the hepatic flexure was normal, the CA19-9 level continued to increase, indicating tumor recurrence. Subsequently, the patient was treated with 25 fractions of radiotherapy to the peripancreatic lymph nodes followed by tegafur-gimeracil-oteracil potassium maintenance. He went on to achieve a progression-free survival of more than 5 years with good tolerability and no adverse drug induced reaction. More than 9 years into treatment, he continues to enjoy good health and quality of life and is tolerating the treatment well.

CONCLUSION: This case shows an exceptional long-term survival of a patient with pancreatic cancer with early recurrence after adjuvant chemotherapy treated with maintenance tegafur-gimeracil-oteracil potassium.