Maintenance therapy of low-dose nivolumab, S-1, and leucovorin in metastatic pancreatic adenocarcinoma with a germline mutation of MSH6 : A case report

Immune checkpoint inhibitors (ICIs) provide substantial benefits to a small subset of patients with advanced cancer with mismatch repair deficiency (MMRD) or microsatellite instability (MSI), including patients with pancreatic ductal adenocarcinoma (PDAC). However, the long duration of ICI treatment...

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Bibliographic Details
Published in:Frontiers in immunology 2022-12, Vol.13, p.1077840
Main Authors: Peng, Shang-Hsuan, Chen, Bang-Bin, Kuo, Ting-Chun, Lee, Jen-Chieh, Yang, Shih-Hung
Format: Article
Language:English
Subjects:
Adenocarcinoma - drug therapy
Adenocarcinoma - genetics
Adenocarcinoma - pathology
case report
DNA-Binding Proteins - genetics
Female
Germ-Line Mutation
Humans
Immunology
Leucovorin - therapeutic use
maintenance therapy
Middle Aged
mismatch repair
nivolumab
Nivolumab - therapeutic use
pancreatic ductal adenocarcinoma
Pancreatic Neoplasms
Pancreatic Neoplasms - drug therapy
Pancreatic Neoplasms - genetics
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Summary:Immune checkpoint inhibitors (ICIs) provide substantial benefits to a small subset of patients with advanced cancer with mismatch repair deficiency (MMRD) or microsatellite instability (MSI), including patients with pancreatic ductal adenocarcinoma (PDAC). However, the long duration of ICI treatment presents a considerable financial burden. We present the case of a 63-year-old woman with metastatic PDAC refractory to conventional chemotherapy. Genetic analyses identified an germline mutation and a high tumor mutation burden (TMB). Complete response (CR) was achieved after a short course of low-dose nivolumab (20 mg once every 2 weeks) with chemotherapy. CR was maintained for over 1 year with low-dose nivolumab and de-escalated chemotherapy without any immune-related adverse events. This case supports the further exploration of low-dose, affordable ICI-containing regimens in patients with advanced MSI-high/TMB-high cancer.
ISSN:1664-3224
1664-3224
DOI:10.3389/fimmu.2022.1077840