Synchronous Triple Cancers of the Pancreas, Stomach, and Cecum Treated with S-1 Followed by Pancrelipase Treatment of Pancreatic Exocrine Insufficiency

  • Koushiro Ohtsubo Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Daisuke Ishikawa Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Shigeki Nanjo Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Shinji Takeuchi Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Tadaaki Yamada Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Hisatsugu Mouri Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Kaname Yamashita Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Kazuo Yasumoto Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
  • Toshifumi Gabata Department of Radiology, Kanazawa University. Kanazawa, Japan
  • Osamu Matsui Department of Radiology, Kanazawa University. Kanazawa, Japan
  • Hiroko Ikeda Division of Human Pathology, Kanazawa University. Kanazawa, Japan
  • Yasushi Takamatsu Takamatsu Clinic. Kanazawa, Japan
  • Sakae Iwakami Surgery, Kanazawa West Hospital. Kanazawa, Japan
  • Seiji Yano Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan
Keywords: Cecal Neoplasms, Drug Therapy, Exocrine Pancreatic Insufficiency, Genes, ras, Pancreatic Neoplasms, Pancrelipase, Stomach Neoplasms

Abstract

Context Pancreatic cancer is frequently complicated by malignancies in other organs. However, synchronous triple cancers including pancreatic cancer have been seldom reported in the English language literature. Case report We describe the rare case of a 77-year-old man with triple cancers of the pancreas, stomach, and cecum. Biopsies revealed that all three tumors were adenocarcinomas. The pancreatic and gastric tumors were positive for cytokeratin 7 and negative for cytokeratin 20, whereas the cecal tumor was negative for cytokeratin 7 and positive for cytokeratin 20. K-ras mutations were present at codon 12 in the pancreatic tumor and at codon 13 in the cecal tumor, but were absent from the gastric tumor. Since the three tumors had different characteristics, the patient was diagnosed with synchronous triple cancers. Because invasive surgery was required to remove all three tumors and the patient had risk factors for surgery, we elected to treat him with chemotherapy. All three cancers were markedly reduced in size by treatment with cycles of 100 mg/day S-1 for 2 weeks, followed by a 1-week rest. The patient later developed hypoproteinemia and anasarca, which was diagnosed as pancreatic exocrine insufficiency due to pancreatic head cancer. Treatment with pancrelipase resulted in dramatic improvements in hypoproteinemia and anasarca. Conclusions This is the first case report in which S-1 was effective in triple cancers of the pancreas, stomach, and cecum. Patients with pancreatic head cancer should be monitored for pancreatic exocrine insufficiency.

Image: Gastric tumor in the middle part of the stomach.

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References

Eriguchi N, Aoyagi S, Hara M, Okuda K, Tamae T, Fukuda S, et al. Synchronous or metachronous double cancers of the pancreas and other organs: report on 12 cases. Surg Today 2000; 30: 718-21. [PMID 11428609]

Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15: 2403-13. [PMID 9196156]

Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al., National Cancer Institute of Canada Clinical Trials Group. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2007; 25: 1960-6. [PMID 17452677]

Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST Study. J Clin Oncol 2013; 31:1640-8. [PMID 23547081]

Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 2008; 9: 215-21. [PMID 18282805]

Boku N, Yamamoto S, Fukuda H, Shirao K, Doi T, Sawaki A, et al.; Gastrointestinal Oncology Study Group of the Japan Clinical Oncology Group Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 2009; 10: 1063-9. [PMID 19818685]

Shirao K, Ohtsu A, Takada H, Mitachi Y, Hirakawa K, Horikoshi N, et al. Phase II study of oral S-1 for treatment of metastatic colorectal carcinoma. Cancer 2004; 100: 2355-61. [PMID 15160338]

Domínguez-Muñoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol 2011; 26 Suppl 2: 12-6. [PMID 21323992]

Bruno MJ, Haverkort EB, Tijssen GP, Tytgat GN, van Leeuwen DJ. Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region. Gut 1998; 42: 92-6. [PMID 9505892]

Sobin LH, Gospodarowicz MK, Wittekind C (eds): UICC. TNM classification of malignant tumours. 7th ed. New York, Wiley-Liss, 2009.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-47. [PMID 19097774]

National Cancer Institute. Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events (CTCAE) v4.0, 2009.

Taira K, Shiraishi M, Sunagawa H, Takushi Y, Shimoji H, Tomita S, et al. Resection of triple synchronous cancers: a case report. Hepatogastroenterology 1999; 46: 199-203. [PMID 10228792]

Sato K, Maekawa T, Yabuki K, Tamasaki Y, Maekawa H, Kudo K, et al. A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. J Gastroenterol 2003; 38: 97-100. [PMID 12560930]

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology-v.2012.

Bos JL. ras oncogenes in human cancer: a review. Cancer Res 1989; 49: 4682-9. [PMID 2547513]

Smit VT, Boot AJ, Smits AM, Fleuren GJ, Cornelisse CJ, Bos JL. KRAS codon 12 mutations occur very frequently in pancreatic adenocarcinomas. Nucleic Acids Res 1988; 16: 7773-82. [PMID 3047672]

Shirasaka T, Shimamato Y, Ohshimo H, Yamaguchi M, Kato T, Yonekura K, et al. Development of a novel form of an oral 5-fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5-fluorouracil by two biochemical modulators. Anticancer Drugs 1996; 7: 548-57. [PMID 8862723]

Tatsumi K, Fukushima M, Shirasaka T, Fujii S. Inhibitory effects of pyrimidine, barbituric acid and pyridine derivatives on 5-fluorouracil degradation in rat liver extracts. Jpn J Cancer Res 1987; 78: 748-55. [PMID 3114201]

Shirasaka T, Shimamoto Y, Fukushima M. Inhibition by oxonic acid of gastrointestinal toxicity of 5-fluorouracil without loss of its antitumor activity in rats. Cancer Res 1993; 53: 4004-9. [PMID 7689420]

Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. An early phase II study of S-1 in patients with metastatic pancreatic cancer. Oncology 2005; 68: 171-8. [PMID 16006754]

Okusaka T, Funakoshi A, Furuse J, Boku N, Yamao K, Ohkawa S, et al. A late phase II study of S-1 for metastatic pancreatic cancer. Cancer Chemother Pharmacol 2008; 61: 615-21. [PMID 17520253]

Kubota E, Kataoka H, Hayashi K, Kamiya T, Sasaki M, Ogasawara N, et al. Advanced stomach and pancreas cancer successfully treated with combination chemotherapy with S-1/paclitaxel/lentinan. Hepatogastroenterology 2009; 56: 106-10. [PMID 19453038]

Watson L. Exocrine insufficiency and pancreatic enzyme replacement therapy in pancreatic cancer. Clin Oncol 2010; 22: 390-2. [PMID 20466283]

Pancreatic Section, British Society of Gastroenterology; Pancreatic Society of Great Britain and Ireland; Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of Pathologists; Special Interest Group for Gastro-Intestinal Radiology. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005; 54 Suppl 5: v1-16. [PMID 15888770]

Whitcomb DC, Lehman GA, Vasileva G, Malecka-Panas E, Gubergrits N, Shen Y, et al. Pancrelipase delayed-release capsules (CREON) for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: A double-blind randomized trial. Am J Gastroenterol 2010; 105: 2276-86. [PMID 20502447]

Gastric tumor in the middle part of the stomach
Published
2013-09-10
How to Cite
OhtsuboK., IshikawaD., NanjoS., TakeuchiS., YamadaT., MouriH., YamashitaK., YasumotoK., GabataT., MatsuiO., IkedaH., TakamatsuY., IwakamiS., & YanoS. (2013). Synchronous Triple Cancers of the Pancreas, Stomach, and Cecum Treated with S-1 Followed by Pancrelipase Treatment of Pancreatic Exocrine Insufficiency. JOP. Journal of the Pancreas, 14(5), 515-520. https://doi.org/10.6092/1590-8577/1719

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