Tobias Polak

Chapter 7 158 TL-118-anti-angiogenic treatment in pancreatic cancer: a case report. Setup This case report describes the use of TL-118 anti-angiogenic treatment in combination with chemotherapy via compassionate use. Data were retrospectively collected. Comments on ethical approval, funding or informed consent are lacking in the report. Patients The expanded access program was open to a 75-year-old female diagnosed with pancreatic cancer. She was inoperable and a stent was inserted into the common bile duct (CBD) to drain the biliary tract. In July 2011, she was treated with palliative chemotherapy consisting of gemcitabine and TL-118 via compassionate use. Interventions The patient received gemcitabine (1,000 mg/m2 day 1, 8, 15, 28 days) and daily doses of TL118, an anti-angiogenic combination of four drugs, cimetidine (antihistamine), metronomic cyclophosphamide (alkylating agent), diclofenac (nonsteroidal anti-inflammatory drug) and Sulfasalazine, an (angiogenesis inhibitor) orally. There was a temporary interruption of five months due to treatment related adverse events. Outcome Progression free survival (PFS), tumor markers (CA19-9) and adverse events were evaluated. After three months of gemcitabine and TL-118 treatment, tumor markers and tumor size decreased; after six and eight months the patient ‘nearly reached complete remission’. On January 2012, the treatment with TL-118 was put on hold due to side effects, which included weakness and vomiting, and the patient was treated with gemcitabine monotherapy until April 2012. Between April and June, the patient did not receive any treatment because of cholangitis and stent replacement. In May 2012, tumor markers went up, so gemcitabine treatment was reinitiated. As tumor markers were still raising, TL-118 treatment was introduced again in October 2012. A month after renewal of TL-118 treatment, there was clinical improvement and a ‘drastic reduction’ of tumor marker CA 19-9 again (from 1000 to 345 µ/ml. 16 months post-diagnosis the patient is still receiving TL-18 and gemcitabine and continues to be stable.

RkJQdWJsaXNoZXIy MTk4NDMw