卡铂可能是铂敏感型胰腺癌合并既存神经病变患者一种有效且可耐受的治疗选择

摘要(中文译文)

以铂类为基础的化疗仍是胰腺腺癌治疗的重要组成部分；然而，奥沙利铂和顺铂累积性神经毒性常限制持续治疗。卡铂是一种神经毒性较小的铂类类似物，在其他恶性肿瘤中具有活性，但尚未获批用于胰腺癌。我们描述了一例胰腺腺癌患者，在因神经病变停用奥沙利铂后，接受卡铂治疗获得长期疾病稳定。患者为57岁女性，诊断为胰腺腺癌，接受新辅助FOLFIRINOX（5-氟尿嘧啶、亚叶酸钙、奥沙利铂、伊立替康）、放化疗及胰十二指肠切除术，随后接受辅助吉西他滨和卡培他滨治疗。随着时间推移，她出现疑似局部区域复发，并接受了多种后续全身治疗，包括FOLFIRINOX再挑战、5-氟尿嘧啶联合脂质体伊立替康，以及吉西他滨联合白蛋白结合型紫杉醇。这些方案因不耐受、疾病进展和周围神经病变加重而受限。鉴于非铂类方案治疗中出现进展且神经病变加重，但既往奥沙利铂治疗曾获得疾病控制，患者开始接受卡铂治疗。初始影像显示腹水改善、腹膜后病变稳定。她在约10个月内共13个周期获得影像学疾病稳定，神经病变未加重，直至最终疾病进展。本病例提示，对于似乎能从铂类治疗中获益但因神经病变无法耐受奥沙利铂或顺铂的特定胰腺腺癌患者，卡铂可能是合理选择。尽管临床数据有限，既往研究已显示以卡铂为基础方案的适度疗效和良好毒性特征。对于铂类敏感且存在累积性神经病变的患者，卡铂或可考虑作为替代铂类药物或转换维持策略。

Abstract

Platinum-based chemotherapy remains an important component of treatment for pancreatic adenocarcinoma; however, cumulative neurotoxicity from oxaliplatin and cisplatin often limits continued therapy. Carboplatin is a less neuropathic platinum analogue with activity in other malignancies, but it is not approved for pancreatic cancer. We describe a patient with pancreatic adenocarcinoma who achieved prolonged disease stability on carboplatin after discontinuation of oxaliplatin due to neuropathy. A 57-year-old woman presented with pancreatic adenocarcinoma and was treated with neoadjuvant FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, irinotecan), chemoradiation, and pancreaticoduodenectomy, followed by adjuvant gemcitabine and capecitabine. Over time, she developed suspected locoregional recurrence and received multiple subsequent systemic therapies, including FOLFIRINOX rechallenge, 5-fluorouracil with liposomal irinotecan, and gemcitabine with nab-paclitaxel. These regimens were limited by intolerance, disease progression, and worsening peripheral neuropathy. Given progression on non-platinum regimens and increasing neuropathy, but prior disease control with oxaliplatin, the patient was started on carboplatin. Initial imaging showed improvement in ascites and stabilization of retroperitoneal disease. She experienced radiographically stable disease for 13 cycles over approximately 10 months without worsening neuropathy before eventual disease progression. This case suggests that carboplatin may be a reasonable option for select patients with pancreatic adenocarcinoma who appear to benefit from platinum therapy but cannot tolerate oxaliplatin or cisplatin due to neuropathy. While clinical data are limited, prior studies have demonstrated modest efficacy and a favorable toxicity profile with carboplatin-based regimens. Carboplatin may warrant consideration as an alternative platinum agent or as a switch-maintenance strategy in patients with platinum sensitivity and cumulative neuropathy.

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