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Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 107–111 (2008)Cite this article

Abstract

Background A 72-year-old white male presented to a University Digestive Disease Center with epigastric pain and weight loss. A CT scan suggested that the patient had a mass in his pancreas and he was referred for further diagnostic work-up, staging and treatment.

Investigations Endoscopic ultrasound (EUS), EUS-guided fine-needle aspiration

Diagnosis Locally advanced, unresectable adenocarcinoma of the pancreas

Management Opioid analgesics and EUS-guided celiac neurolysis (transgastric injection of bupivacaine and alcohol on both sides of the celiac artery) for pain relief. Five once-weekly intratumoral injections of TNFerade™ (GenVec, Inc., Gaithersburg, MD) by EUS-guided fine needle injection, in combination with chemoradiation (5 FU/XRT), as part of a multicenter clinical trial. Repeat fine-needle aspiration followed by surgical resection of the tumor.

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Figure 1: Endoscopic ultrasound-guided injection of TNFerade™ into a pancreatic tumor during the first week of treatment.
Figure 2: Endoscopic ultrasound images of the pancreatic tumor shrinking with subsequent injections of TNFerade™.
Figure 3: An endoscopic ultrasound image showing negative fine-needle aspiration 1 month after therapy.
Figure 4: Gross specimen of the resected pancreas with no residual tumor remaining.
Figure 5: Histology specimen confirming a pathologic complete response.

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Acknowledgements

We would like to thank Elyse Roth McDonnell, Amy Tan, Chi Lee, MPH Sentelle Eubanks, and Jaimee Hartman for contributing in coordinating and administering the TNFerade™ Clinical Trials at University of California, Irvine.

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Authors and Affiliations

  1. and R Muthusamy is Assistant Clinical Professor in the Division of Gastroenterology, Department of Medicine; RF Holcombe is Professor and Chief in the Division of Hematology/Oncology, Department of Medicine; J Kuo is Associate Clinical Professor in the Department of Radiation Oncology; ML Wu is Assistant Professor of Clinical Pathology in the Department of Pathology, KJ Chang is Professor of Clinical Medicine and Executive Director of the Comprehensive Digestive Disease Center, JG Lee is Associate Professor of Clinical Medicine and Associate Director of the Comprehensive Digestive Disease Center, HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA, USA.,

    Kenneth J Chang, John G Lee, Randall F Holcombe, Jeffrey Kuo, Raman Muthusamy & Mark L Wu

  2. RF Holcombe is Professor and Chief in the Division of Hematology/Oncology, Department of Medicine,

    Kenneth J Chang, John G Lee, Randall F Holcombe, Jeffrey Kuo, Raman Muthusamy & Mark L Wu

Authors
  1. Kenneth J Chang
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  2. John G Lee
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Corresponding author

Correspondence to Kenneth J Chang.

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Competing interests

KC Chang has acted as a consultant for, and received research support from, GenVec and Olympia.

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Chang, K., Lee, J., Holcombe, R. et al. Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer. Nat Rev Gastroenterol Hepatol 5, 107–111 (2008). https://doi.org/10.1038/ncpgasthep1033

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