[A Resected Case of Advanced Lower Rectal Cancer with Neoadjuvant Chemotherapy by FOLFOXIRI plus Cetuximab].

Although the current standard of care for patients with lower rectal cancer in Japan includes total mesorectal resection with lateral lymph node dissection, postoperative local and distant recurrence rates are high. Multidisciplinary treatment is important to improve the prognosis. A man in his 30s was diagnosed with lower rectal cancer due to bloody stool and referred to our department. He was diagnosed as cT3N3M0, cStage Ⅲc with right obturator lymph node metastasis. Four courses of neoadjuvant chemotherapy(NAC)with FOLFOXIRI plus cetuximab were performed. Because Grade 3 neutropenia was observed in the first cycle(CTCAE v5.0), pegfilgrastim was administered in the second and subsequent cycles, and NAC was completed without dose reduction. The patient underwent laparoscopy-assisted intersphincteric rectal resection and D3+rtLD2 dissection. Histopathological resection margins were negative, and the resection was R0. Lymph node metastasis was found only in No. 263d-rt, and the pathological diagnosis was ypT3N3M0, pStage Ⅲc. Histological evaluation of response to treatment was Grade 2. The postoperative course was good and the patient was discharged on postoperative day 15. The patient received 8 courses of adjuvant chemotherapy with mFOLFOX6 from the 7th postoperative week and is alive and recurrence-free 6 months after surgery.

Combination treatment of advanced pancreatic cancer using novel vaccine and traditional therapies.

INTRODUCTION: Pancreatic cancer is a highly malignant disease with high treatment resistance. Many patients are diagnosed in a very advanced state, and few patients can be curatively resected. With FOLFIRINOX and nab-paclitaxel plus gemcitabine, the prognosis of advanced pancreatic cancer has improved, yet many patients cannot survive longer than a year. Therefore, new therapeutic approaches are needed. Cancer vaccine therapy is characterized by controlling cancer by a cancer-specific immune reaction with few adverse events. Thus, a cancer peptide vaccine is considered promising for pancreatic cancer patients, who are often in poor general condition at diagnosis. Areas covered: This article reviews available data from recent clinical trials of the novel cancer vaccine therapy in combination with traditional chemotherapy or radiotherapy for pancreatic cancer, and the prospect will be described. Expert commentary: In clinical trials of the novel cancer vaccine therapy in combination with traditional therapy, many studies have failed to outperform traditional therapy, although some effects were recognized in subgroups. What is necessary in the future for cancer vaccine therapy to improve the prognosis of pancreatic cancer is combination of immune-checkpoint blockade to release immune escape mechanism and combination with strong multi-drug combination chemotherapy.

[A Case of Borderline Resectable Pancreatic Cancer Responding to Preoperative GEM plus Nab-PTX Combination Chemotherapy].

We report a case of borderline resectable(BR)pancreatic cancer, which was eligible for R0 resection following preoperative chemotherapy with GEM plus nab-PTX. A 77-year-old woman presented with brown urine and clay-colored stool. After further examination, she was diagnosed with obstructive jaundice due to pancreatic head cancer. Because the tumor was in contact with the region attached to the SMA nerve plexus, she was also diagnosed with BR-A pancreatic cancer. After 6 courses of preoperative GEM plus nab-PTX combination chemotherapy, she underwent subtotal stomach-preservingpancreaticoduodenectomy with SMV resection and right semicircular SMA nerve plexus dissection. In the histopathological diagnosis, malignant cells were observed at low levels in both the pancreatic parenchyma and duodenal mucosa. There were no findings of residual malignant cells in the wall of the SMV or in the nerve plexus around the SMA. Since the final diagnosis was pT3,(DU+), pN0, cM0, fStage III , we concluded that the R0 resection as complete. Histological therapeutic evaluation with the Evans classification concluded that the disease was Grade III . GEM plus nab-PTX combination chemotherapy could be considered for preoperative chemotherapy, which may allow R0 resection for BR pancreatic cancer.