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Case of pancreatic cancer 2

Case 2 When pancreatic cancer was detected, it could not be treated with surgery due to multiple hepatic metastases and peritoneal metastasis.

This patient experienced severe abdominal pain in May, 2006. The pain was found to be due to necrosis of spleen (an organ located in left abdominal area). Detailed examination at a university hospital revealed pancreatic cancer and that cancer spread to arteries of spleen, clogged these arteries and caused necrosis of spleen. In addition, pancreatic cancer already developed metastases in liver and peritoneum. The cancer was at Stage IVb, at which it cannot be treated with surgery.
Drip infusion of Gemzar, which is a standard therapy, was started. Tumor markers were decreased temporarily, but increased again rapidly. Therefore, combined use of an oral anticancer agent, TS-1, was started in October. As a result, CA19-9 (one of the tumor markers) was slightly decreased, but CEA (another tumor marker) continued to rise. Thus, the effect of the combination was not sufficient.
The university hospital referred the patient to the New City Osaki Clinic. While continuing the administration of anticancer agents, immune cell therapy of our clinic was given once a week for four weeks starting in November of the same year and every other week after that. Both tumor markers, CA19-9 and CEA, were decreased to lower than one tenth after one month of the treatment (Figure 1). The CT images obtained three months later showed a reduction of the size of hepatic metastases and disappearance of metastatic tumor in the abdominal area (Photos 1 and 2). In addition, a subjective symptom of persistent pain in left back area was resolved.

Figure 1  Pancreatic cancer, multiple hepatic metastases, peritoneal metastasis

Photo 1  Abdominal CT images: multiple hepatic metastases

Photo 2  Abdominal CT images: intraperitoneal metastatic tumor

For this patient, 35 cc of blood was drawn per blood collection every two weeks and for the first four times of administration, the lymphocytes from one blood collection were divided into two for two times of weekly administration. Despite weakened immunity, on average, 20.3 billion activated lymphocytes were grown by culture per one blood collection. Among them, 11.4 billion lymphocytes (about 55%), on average, were NK (natural killer) cells. NK cells were cultured in a way that allows them to present TRAIL molecules (molecules that send death signal to cancer) well on the surface of the cells.
The peripheral blood lymphocyte count increased from 1700/μl to 3800/μl after the treatment. When NK activity was examined (by collecting 5 cc of blood: normal reference value, 18 to 40%) before and after the treatment, it increased markedly from 13% before the treatment to 44% after two weeks of treatment and to 55% after four weeks of treatment. The proportion of NK cells also increased from 4% to 25%. Moreover, the proportion of NKG2D-positive lymphocytes that was originally 30% was almost doubled (Figure 2).

Figure 2  Change in peripheral blood lymphocyte caused by treatment

It is very difficult to detect pancreatic cancer early. At the time of diagnosis, 70 to 80% of the patients have metastasis and many of these patients cannot be treated with surgery. Therefore, among different types of gastrointestinal cancer, pancreatic cancer is considered most difficult to treat. Recently, combined use of TS-1 has been reported to increase the efficacy of Gemzar (both drugs are covered by insurance when they are used for the treatment of pancreatic cancer).
In this patient, CA19-9 was slightly decreased after TS-1 was added during the treatment with Gemzar, but this effect was not so great. However, after highly active NK cell therapy was added to these anticancer agents, tumor markers were dramatically lowered and the reduced size as well as the disappearance of tumors were confirmed by CT scan.
Moreover, increases in peripheral blood lymphocyte count, NK cell count, NK activity, and NKG2D-positive cells were observed. Thus, objective data clearly showing the enhancement of immunity were obtained. Nevertheless, pancreatic cancer is a tough enemy, so we still have to be vigilant. We will continue the treatment with extreme caution in collaboration with the university hospital.

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List of cases of pancreatic cancer

Case of pancreatic cancer 1
Case of pancreatic cancer 2

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Cancer immunotherapy

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