PURPOSE: Pancreatic
acinar cell carcinoma (ACC) is a rare
cancer of the
exocrine pancreas . Because of its rare
incidence , the
efficacy of
chemotherapy in this
patient population has been largely unknown. Therefore, we retrospectively analyzed the outcomes of
patients with advanced pancreatic ACC
who received
chemotherapy . MATERIALS AND
METHODS: Between January 1997 and March 2015, 15
patients with unresectable or metastatic pancreatic ACC
who received systemic
chemotherapy were identified in Asan Medical Center,
Korea .
RESULTS: The median age was 58 years. Eleven and four
patients had recurrent/metastatic and locally advanced unresectable
disease . The median overall
survival in all
patients was 20.9 months (95%
confidence interval [CI], 15.7 to 26.1). As first-line
therapy , intravenous
5-fluorouracil were administered in four
patients (27%),
gemcitabine in five (33%),
gemcitabine plus
capecitabine in two (13%),
oxaliplatin plus
5-fluorouracil /
leucovorin (FOLFOX) in two (13%), and
concurrent chemoradiotherapy followed by
capecitabine maintenance therapy in two (13%). The objective response rate (ORR) to
chemotherapy alone was 23% and the median
progression-free survival (PFS) was 5.6 months (95% CI, 2.8 to 8.4). After progression, second-line
chemotherapy was administered in eight
patients , while four
patients received FOLFOX and the other four
patients received
gemcitabine . The ORR was 38%, and
patients administered FOLFOX had significantly better PFS than those administered
gemcitabine (median, 6.5 months vs. 1.4 months; p=0.007). The ratio of
time to
tumor progression (TTP) during first-line
chemotherapy to TTP at second-line
chemotherapy was significantly higher in
patients administered FOLFOX (4.07; range, 0.87 to 8.30) than in those administered
gemcitabine (0.12; range, 0.08 to 0.25; p=0.029).
CONCLUSION: Our results suggest that
oxaliplatin -containing regimens may have improved activity against pancreatic ACC.