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*Only for medical professionals to read for reference, Dr.
Chao Han won the first prize in the "100 "Case" Select One Classic Case Show SHOW Hepatobiliary and Pancreatic Special Show, and see how the cases shared by Dr.
Chao Han surprised the audience
.
One hundred "cases" and one case collection activity is sponsored by the Beijing Xisk Clinical Oncology Research Foundation, the Chinese Society of Clinical Oncology (CSCO), and co-organized by the medical community.
Through the model of case collection, it builds academic communication bridges and focuses on standardized tumor diagnosis and treatment.
, Collect standardized diagnosis and treatment cases from the majority of young and middle-aged doctors, especially primary doctors, to promote the process of standardized tumor diagnosis and treatment
.
From September 25th to 29th, the 24th National Conference on Clinical Oncology and the 2021 CSCO Academic Annual Meeting were held
.
On the afternoon of September 26, at the grassroots special session of the Beijing Hesco Clinical Oncology Research Foundation, the final evaluation site of this year's 100 "cases" selection-the classic case show SHOW (digestive tract & liver, gallbladder and pancreas) was officially unveiled
.
In the hepatobiliary and pancreatic session, Professor Qin Shukui of the General Hospital of the Eastern Theater Command, Professor Liang Jun from Peking University International Hospital, Professor Liang Houjie from the Southwest Hospital of the Army Military Medical University served as consultants, Professor Chen Xiaofeng from Jiangsu Provincial People's Hospital, Professor Fang Weijia from the First Affiliated Hospital of Zhejiang University School of Medicine, Shanghai Professor Shi Yan from Ruijin Hospital Affiliated to Jiaotong University School of Medicine, Professor Gong Xinlei from Nanjing Jinling Hospital, and Professor Xue Junli from Oriental Hospital Affiliated to Tongji University served as mentors to comment on selected cases and discuss hot topics
.
After fierce competition, Dr.
Chao Han from Xintai City People's Hospital of Shandong Province, who finally shared the case of advanced pancreatic cancer with combined immunotherapy, won the first prize in the hepatobiliary and pancreatic special event
.
The Medical Oncology Channel specially sorts out and interprets the diagnosis and treatment of the case and the content of expert comments for readers
.
Figure 1.
Dr.
Chao Han’s case sharing The basic situation of the case: the patient is male, 68 years old
.
Date of first visit: July 2020
.
Main complaint: Pain in the upper abdomen for more than 3 months, and pancreatic cancer was discovered for 1 week
.
History of present illness: 3 months ago, the patient had no obvious cause for upper abdominal pain and discomfort, self-administered oral proton pump inhibitor (PPI) and other gastric-protecting drugs, the effect was poor, the pain was progressively worsening, the patient received enhanced chest and abdomen CT 1 week ago Prompt "pancreatic cancer with multiple liver metastases"
.
Past history: past physical fitness, a small amount of smoking and drinking history
.
Physical examination: physical status: PS score is 1 point, NRS score is 3 points, PG-SGA score is 2 points, and direct bilirubin (DBIL) is 5 ummol/L
.
General physical examination: the body's superficial lymph nodes were not enlarged, the chest was symmetrical, the lungs were clear breath sounds, no abnormal breath sounds and dry and wet rales were heard, and there was no pleural friction sound
.
The heart rate is 75 beats/min, the heart rhythm is uniform, the heart sounds are strong, and there are no murmurs and pericardial friction sounds in each valve area
.
Specialist physical examination: flat and soft abdomen, mild tenderness in the mid-abdomen, no masses, no reach under the liver, spleen, ribs, no gallbladder, Murphy sign (Murphy) negative; no tenderness and percussion pain in both kidneys, wheat Mc Burney is negative, mobile dullness is negative, bowel sounds are 4-5 times/min
.
Laboratory examination: Carcinoembryonic antigen (CEA)>1000ng/ml, sugar chain antigen 199 (CA199)>1000KU/L
.
Imaging examination: consider pancreatic cancer with multiple metastases in the liver, portal vein, splenic arteries and veins, and common hepatic arteries are involved
.
Figure 2.
CT examination results.
Genetic testing: high degree of microsatellite instability (MSI-H), PALB2 mutations, no other targeted therapy-related gene mutations
.
Clinical diagnosis: metastatic pancreatic ductal adenocarcinoma (mPDAC), staged as cT4NXM1 stage IV
.
After diagnosis and treatment, according to the recommendations of the 2020 CSCO Pancreatic Cancer Diagnosis and Treatment Guidelines, as well as clinical data, the overall survival (OS) of patients with advanced pancreatic cancer with tumor mutation burden (TMB) ≥9mut/MB receiving immune combination chemotherapy was significantly higher than that of chemotherapy alone ( 14.
6 months vs.
1.
25 months) [1,2], decided to perform a combination therapy of tislelizumab (200mg) + gemcitabine (1.
6g d1, 8) + oxaliplatin (150mg d2 q3w)
.
From July 2020 to September 2020, after the patient received the combination regimen for 2 cycles, the abdominal pain symptoms disappeared, the NRS score dropped to 0-1 points, CA199 dropped to 861KU/L, CEA dropped to 77.
77ng/ml, CT review It showed that the total diameter of the target lesion was reduced by >30% compared with the previous one, and the curative effect was evaluated as partial remission (PR)
.
Figure 3.
CT examination results before treatment and after 2 cycles of treatment.
Until November 2020, the patient has received 5 cycles of tislelizumab + gemcitabine + oxaliplatin combination therapy
.
CA199 continued to fall, and CEA continued to stabilize at a low value
.
CT re-examination showed that the primary tumor and some liver metastases continued to decrease and shrink, and the efficacy evaluation was still PR
.
Figure 4.
CT examination results after 2 cycles and 5 cycles of treatment As of March 2021, the patient has completed 8 cycles of tislelizumab + gemcitabine + oxaliplatin combined therapy, and the efficacy evaluation is still PR , The progression-free survival (PFS) of this patient was as long as 8 months
.
Case summary and analysis Today's tumor treatment is developing rapidly, and standardized anti-tumor treatment is the best treatment given to patients by grassroots doctors.
.
The genetic test result of this patient with advanced metastatic unresectable pancreatic cancer showed MSI-H.
With the guidance of the 2020 CSCO Pancreatic Cancer Diagnosis and Treatment Guidelines, the choice of the combination plan of tislelizumab + gemcitabine + oxaliplatin was determined.
After 8 cycles of treatment, the patient’s condition continued to be PR, and PFS lasted up to 8 months.
Whether PFS benefit can ultimately be transformed into OS benefit requires further observation
.
Figure 5.
Changes in tumor marker levels during treatment.
Immunization combined with chemotherapy provides us with new treatment ideas and is expected to become a first-line treatment for mPDAC
.
The patient in this case is "hot tumor", but more patients are "cold tumor"
.
The next step worthy of the medical community’s attention and research is how to transform “cold tumors” into “warm tumors” through immunization combined with radiotherapy and chemotherapy or other methods, and provide more micro-organisms for the application of PD-1/PD-L1 inhibitors.
Environmental support
.
Special tutor's comments and questions Figure 6.
Specially invited tutor Professor Xue Junli's comments and questions As a guest tutor, Professor Xue Junli commented and pointed out that Dr.
Chao Han elaborated on clinical data and authoritative guidelines recommendations in the case report, which added luster to this case
.
Professor Xue Junli asked two questions: ① Jobs suffered from pancreatic neuroendocrine tumor.
How is the treatment different from this case of pancreatic ductal adenocarcinoma? ②Currently, what are the new developments in the immunotherapy of pancreatic neuroendocrine tumors? Dr.
Chao Han replied that the treatment of pancreatic neuroendocrine tumors is fundamentally different from that of pancreatic ductal adenocarcinoma
.
The chemotherapeutic drugs for pancreatic neuroendocrine tumors are mainly platinum, and the frequently selected options include the EP regimen containing etoposide.
For pancreatic ductal adenocarcinoma, the first-line chemotherapeutic drugs recommended by the 2020 CSCO guidelines include gemcitabine, albumin paclitaxel, Platinum and Tiggio
.
The application of immunotherapy in pancreatic neuroendocrine tumors is tricky.
Dr.
Chao Han said that in the process of reading the literature, no new and impressive research progress has been discovered for the time being
.
Reference: [1] 2021 edition of "Chinese Society of Clinical Oncology (CSCO) Pancreatic Cancer Diagnosis and Treatment Guidelines".
[2] Daniel John Renouf, et al.
CCTG PA.
7 trial.
2021ASCO-GI Abstract 411 *This article is only for reference Scientific information provided by medical professionals does not represent the views of this platform
Chao Han won the first prize in the "100 "Case" Select One Classic Case Show SHOW Hepatobiliary and Pancreatic Special Show, and see how the cases shared by Dr.
Chao Han surprised the audience
.
One hundred "cases" and one case collection activity is sponsored by the Beijing Xisk Clinical Oncology Research Foundation, the Chinese Society of Clinical Oncology (CSCO), and co-organized by the medical community.
Through the model of case collection, it builds academic communication bridges and focuses on standardized tumor diagnosis and treatment.
, Collect standardized diagnosis and treatment cases from the majority of young and middle-aged doctors, especially primary doctors, to promote the process of standardized tumor diagnosis and treatment
.
From September 25th to 29th, the 24th National Conference on Clinical Oncology and the 2021 CSCO Academic Annual Meeting were held
.
On the afternoon of September 26, at the grassroots special session of the Beijing Hesco Clinical Oncology Research Foundation, the final evaluation site of this year's 100 "cases" selection-the classic case show SHOW (digestive tract & liver, gallbladder and pancreas) was officially unveiled
.
In the hepatobiliary and pancreatic session, Professor Qin Shukui of the General Hospital of the Eastern Theater Command, Professor Liang Jun from Peking University International Hospital, Professor Liang Houjie from the Southwest Hospital of the Army Military Medical University served as consultants, Professor Chen Xiaofeng from Jiangsu Provincial People's Hospital, Professor Fang Weijia from the First Affiliated Hospital of Zhejiang University School of Medicine, Shanghai Professor Shi Yan from Ruijin Hospital Affiliated to Jiaotong University School of Medicine, Professor Gong Xinlei from Nanjing Jinling Hospital, and Professor Xue Junli from Oriental Hospital Affiliated to Tongji University served as mentors to comment on selected cases and discuss hot topics
.
After fierce competition, Dr.
Chao Han from Xintai City People's Hospital of Shandong Province, who finally shared the case of advanced pancreatic cancer with combined immunotherapy, won the first prize in the hepatobiliary and pancreatic special event
.
The Medical Oncology Channel specially sorts out and interprets the diagnosis and treatment of the case and the content of expert comments for readers
.
Figure 1.
Dr.
Chao Han’s case sharing The basic situation of the case: the patient is male, 68 years old
.
Date of first visit: July 2020
.
Main complaint: Pain in the upper abdomen for more than 3 months, and pancreatic cancer was discovered for 1 week
.
History of present illness: 3 months ago, the patient had no obvious cause for upper abdominal pain and discomfort, self-administered oral proton pump inhibitor (PPI) and other gastric-protecting drugs, the effect was poor, the pain was progressively worsening, the patient received enhanced chest and abdomen CT 1 week ago Prompt "pancreatic cancer with multiple liver metastases"
.
Past history: past physical fitness, a small amount of smoking and drinking history
.
Physical examination: physical status: PS score is 1 point, NRS score is 3 points, PG-SGA score is 2 points, and direct bilirubin (DBIL) is 5 ummol/L
.
General physical examination: the body's superficial lymph nodes were not enlarged, the chest was symmetrical, the lungs were clear breath sounds, no abnormal breath sounds and dry and wet rales were heard, and there was no pleural friction sound
.
The heart rate is 75 beats/min, the heart rhythm is uniform, the heart sounds are strong, and there are no murmurs and pericardial friction sounds in each valve area
.
Specialist physical examination: flat and soft abdomen, mild tenderness in the mid-abdomen, no masses, no reach under the liver, spleen, ribs, no gallbladder, Murphy sign (Murphy) negative; no tenderness and percussion pain in both kidneys, wheat Mc Burney is negative, mobile dullness is negative, bowel sounds are 4-5 times/min
.
Laboratory examination: Carcinoembryonic antigen (CEA)>1000ng/ml, sugar chain antigen 199 (CA199)>1000KU/L
.
Imaging examination: consider pancreatic cancer with multiple metastases in the liver, portal vein, splenic arteries and veins, and common hepatic arteries are involved
.
Figure 2.
CT examination results.
Genetic testing: high degree of microsatellite instability (MSI-H), PALB2 mutations, no other targeted therapy-related gene mutations
.
Clinical diagnosis: metastatic pancreatic ductal adenocarcinoma (mPDAC), staged as cT4NXM1 stage IV
.
After diagnosis and treatment, according to the recommendations of the 2020 CSCO Pancreatic Cancer Diagnosis and Treatment Guidelines, as well as clinical data, the overall survival (OS) of patients with advanced pancreatic cancer with tumor mutation burden (TMB) ≥9mut/MB receiving immune combination chemotherapy was significantly higher than that of chemotherapy alone ( 14.
6 months vs.
1.
25 months) [1,2], decided to perform a combination therapy of tislelizumab (200mg) + gemcitabine (1.
6g d1, 8) + oxaliplatin (150mg d2 q3w)
.
From July 2020 to September 2020, after the patient received the combination regimen for 2 cycles, the abdominal pain symptoms disappeared, the NRS score dropped to 0-1 points, CA199 dropped to 861KU/L, CEA dropped to 77.
77ng/ml, CT review It showed that the total diameter of the target lesion was reduced by >30% compared with the previous one, and the curative effect was evaluated as partial remission (PR)
.
Figure 3.
CT examination results before treatment and after 2 cycles of treatment.
Until November 2020, the patient has received 5 cycles of tislelizumab + gemcitabine + oxaliplatin combination therapy
.
CA199 continued to fall, and CEA continued to stabilize at a low value
.
CT re-examination showed that the primary tumor and some liver metastases continued to decrease and shrink, and the efficacy evaluation was still PR
.
Figure 4.
CT examination results after 2 cycles and 5 cycles of treatment As of March 2021, the patient has completed 8 cycles of tislelizumab + gemcitabine + oxaliplatin combined therapy, and the efficacy evaluation is still PR , The progression-free survival (PFS) of this patient was as long as 8 months
.
Case summary and analysis Today's tumor treatment is developing rapidly, and standardized anti-tumor treatment is the best treatment given to patients by grassroots doctors.
.
The genetic test result of this patient with advanced metastatic unresectable pancreatic cancer showed MSI-H.
With the guidance of the 2020 CSCO Pancreatic Cancer Diagnosis and Treatment Guidelines, the choice of the combination plan of tislelizumab + gemcitabine + oxaliplatin was determined.
After 8 cycles of treatment, the patient’s condition continued to be PR, and PFS lasted up to 8 months.
Whether PFS benefit can ultimately be transformed into OS benefit requires further observation
.
Figure 5.
Changes in tumor marker levels during treatment.
Immunization combined with chemotherapy provides us with new treatment ideas and is expected to become a first-line treatment for mPDAC
.
The patient in this case is "hot tumor", but more patients are "cold tumor"
.
The next step worthy of the medical community’s attention and research is how to transform “cold tumors” into “warm tumors” through immunization combined with radiotherapy and chemotherapy or other methods, and provide more micro-organisms for the application of PD-1/PD-L1 inhibitors.
Environmental support
.
Special tutor's comments and questions Figure 6.
Specially invited tutor Professor Xue Junli's comments and questions As a guest tutor, Professor Xue Junli commented and pointed out that Dr.
Chao Han elaborated on clinical data and authoritative guidelines recommendations in the case report, which added luster to this case
.
Professor Xue Junli asked two questions: ① Jobs suffered from pancreatic neuroendocrine tumor.
How is the treatment different from this case of pancreatic ductal adenocarcinoma? ②Currently, what are the new developments in the immunotherapy of pancreatic neuroendocrine tumors? Dr.
Chao Han replied that the treatment of pancreatic neuroendocrine tumors is fundamentally different from that of pancreatic ductal adenocarcinoma
.
The chemotherapeutic drugs for pancreatic neuroendocrine tumors are mainly platinum, and the frequently selected options include the EP regimen containing etoposide.
For pancreatic ductal adenocarcinoma, the first-line chemotherapeutic drugs recommended by the 2020 CSCO guidelines include gemcitabine, albumin paclitaxel, Platinum and Tiggio
.
The application of immunotherapy in pancreatic neuroendocrine tumors is tricky.
Dr.
Chao Han said that in the process of reading the literature, no new and impressive research progress has been discovered for the time being
.
Reference: [1] 2021 edition of "Chinese Society of Clinical Oncology (CSCO) Pancreatic Cancer Diagnosis and Treatment Guidelines".
[2] Daniel John Renouf, et al.
CCTG PA.
7 trial.
2021ASCO-GI Abstract 411 *This article is only for reference Scientific information provided by medical professionals does not represent the views of this platform
