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Pancreatic 2

Pancreatic CA – A CASE STUDY

Dr. Donato Perez Garcia

67 year-old female with a diagnosis of pancreatic cancer, pathologically confirmed on 6/25/02. Biopsy was obtained via ERCP and demonstrated involvement of the superior and mesenteric veins. A temporary stent was placed at this time. Also, metastases to the liver were mentioned as a possibility. Patient was not a candidate for the Whipple procedure. Imaging on CAT scan showed a three cm mass in the head of the pancreas. A permanent bile duct stent was placed on 10/29/02.

Patient’s past medical history is significant for a myocardial infarction in 1975, CABG 1987, and again in 1/01. Patient also had hypertension, hypercholesterolemia, chronic atrial fibrillation, managed with appropriate medications. She also has a history of a right inguinal hernia repair. Patient smoked for 20 years but quit as of September 2002.

Initial Treatment

From 8/1/02 to 9/13/02 the patient received radiation to the head of the pancreas combined with six cycles of 5 FU at the University of Minnesota. CT scan on 9/5/02 showed 2.7 cm mass on head of pancreas, a low density lesion on the dome of the liver and dense material within gallbladder. Patient refused further conventional chemotherapy due to the side effects of same. She sought a second opinion and decided instead to be treated with a course of fractionated low-dose chemotherapy with insulin biologic response modification otherwise known as Insulin Potentiation Therapy [IPT]. This was done at the office of Steven G. Ayre, MD, Contemporary Medicine in Burr Ridge, IL.

IPT Treatment

Patient presented for treatment with IPT on 10/2/02. Patient’s complaints were of mild to moderate abdominal pain, fatigue, and decreased appetite. The CA 19-9 level was 651. Patient received twice weekly IPT treatments for the first three weeks with 5FU 100 mg, Leucovorin 100 mg, Camptosar 30 mg, Gemzar 50 mg. These agents were administered in a timed fashion, and in conjuction with a bolus dose of Humalog 10 units. A mild hypoglycemic reaction ensued and was managed in a timely fashion – following administration of the chemotherapy – with the administration of 50% hypertonic glucose solution.

A CT scan performed after three weeks of treatment showed no visible change in the pancreatic mass. A repeat CA 19-9 level at this time showed significant reduction with a value of 204. Subsequent tumor marker levels measured on 12/9/03 and 4/19/04 reported values of 89 and 29 respectively. Coincident with these laboratory findings, patient reported relief from her abdominal pain, increased energy levels, and improved appetite. There were no chemotherapy associated side -effects resulting from this treatment.

A CT Scan from 3/12/03 concluded, “no findings to suggest definitive progression of disease or metastatic involvement.” A subsequent PET scan done on 3/26/03 reported, “no convincing evidence of residual or recurrent tumor.”

The patient’s gallbladder had shown problematic findings since the onset of her illness, and a cholecystectomy was performed on 4/10/03. Subsequently, a CT Scan on 8/20/03 showed a small mass on the head of the pancreas measuring 2×2 cm. A second round of IPT was administered starting 10/29/03 and ending 9/7/04. The CA 19-9 level was 47 on 11/07/03, and went down to 25 on 5/17/04, eventually falling to 12 U/ml in July 2004. A CT scan report dated 7/2/04 showed “no significant change in the appearance of the pancreas.”

After completing her 45th treatment on 9/7/04 in Burr Ridge, IL, the patient decided to seek IPT closer to home. She started treatments with Thomas Sult, MD at Integracare/Williams Clinic in Sartell, MN on 9/24/04. The patient received a total of 19 treatments under Dr. Sult’s care, the last dated 3/2/2005. During this period of active treatment, the patient received various combinations of standard chemotherapy drugs, deliberate changes in these being governed by changes in the patient’s CA 19-9 levels. The patient elected to forego further medical treatment after her final one on 3/2/2005.

The patient died on May 30, 2005. Significantly, the patient experienced little to no serious side-effects or complications as a result of her chemotherapy treatments. From Dr. Sult’s notes dated 10/7/04, though “diagnosed over 2 years ago and while does have measurable disease by scanning, [the patient] has no outward appearance of disease.”