Complete remission in patients with pancreatic cancer: A rare but sometimes achievable event

Background: Treatment of nonresectable pancreatic cancer is often controversial, and best supportive care is considered a sufficient control group for investigational drug trials. Individual cases with remarkable responses call this caution regarding therapy into question. Case Report: We report 2 patients with histologically proven nonresectable primary or recurrent pancreatic cancer. The initial CT scan showed well demarcated pancreatic tumors in head and tail of the pancreas, respectively. Both patients achieved complete remission after 6 cycles of chemotherapy. Patient I (61 years, male), was treated with gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 starting the next cycle on day 29. Patient II (76 years, male) was included into a phase II trial with 5-fluorouracil (500 mg/m(2) i.v. days 2-6) plus Ginkgo biloba extract (GBE-761-ONC, 350 mg total dose i.v. days 1-6) starting the next cycle on day 21. Both regimens were generally well tolerated and showed no major side effects. Both patients were controlled by CT scan. Patient I showed a complete remission (CR) after 6 cylces. Remission was confirmed at the end of treatment and 2, 4, 6, and 8 months after starting the treatment. No evidence of disease was found in the CT scan, although CA 19-9 began to rise 2 months after stop of treatment with gemcitabine. The patient remains well and without measurable disease 14 months after initial diagnosis of the metastatic pancreatic carcinoma. Patient II was first diagnosed 2 years before his first visit in our center. Initially, the patient underwent complete surgical resection and a local recurrence occurred 1 month before the chemotherapy was started. CR was achieved 6 weeks after the treatment initiation and confirmed after 2, 6, and 8 months. The recurrence was diagnosed gastroscopically without evidence of disease in CT scans 2 months after the 9th cycle of chemotherapy. The patient died 13 months after the initial diagnosis of local recurrence and 12 months after treatment initiation. Conclusion: This case report underlines the possibility to offer a palliative therapy to patients with nonresectable pancreatic carcinoma. Such results raises questions to the use of placebo within clinical trials.