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Lo Re et al. J Cancer Metastasis Treat 2019;5:81 Journal of Cancer
DOI: 10.20517/2394-4722.2019.30 Metastasis and Treatment

Case Report Open Access

Physical exercise in locally advanced pancreatic
adenocarcinoma: “If I walk, I live. Although one can

die of cancer, now I am living”

Giovanni Lo Re , Silvia Magnaldi , Paolo Doretto , Roberto Innocente , Francesco Lo Re 5
2
1
4
3
1 Medical Oncology and Immune-related tumors, CRO IRCCS, Aviano 33081, Italy.
2 Radiology, AAS5 Pordenonese, Pordenone 33170, Italy.
3 Clinical pathology, AAS5 Pordenonese, Pordenone 33170, Italy.
4 Radiotherapy, Centro di Riferimento Oncologico (CRO), Aviano 33081, Italy.
5 Chemotherapy and Medical Toxicology, Study University, Milan 20129, Italy.
Correspondence to: Dr. Giovanni Lo Re, Medical Oncology and Immune-related tumors, CRO IRCCS, Aviano 33081, Italy.
E-mail: giovanni.lore@cro.it
How to cite this article: Lo Re G, Magnaldi S, Doretto P, Innocente R, Lo Re F. Physical exercise in locally advanced pancreatic
adenocarcinoma: “If I walk, I live. Although one can die of cancer, now I am living”. J Cancer Metastasis Treat 2019;5:81.
http://dx.doi.org/10.20517/2394-4722.2019.30
Received: 30 Aug 2019 First Decision: 28 Oct 2019 Revised: 11 Nov 2019 Accepted: 17 Nov 2019 Published: 17 Dec 2019

Science Editor: Pravin D. Potdar Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
The most widely used chemotherapeutic combinations in locally advanced (LA) or metastatic pancreatic ductal
adenocarcinoma (PDAC) are Nab-Paclitaxel-Gemcitabine (Nab-PCT-GEM) and Fluorouracil, Folinic acid, Oxaliplatin,
and irinotecan (FOLFIRINOX). Chemo-resistance, typical of PDAC, appears to be due to the negative influence
of stroma population cells, namely regulatory T cells (Treg) and myeloid-derived suppressor cells, macrophages
with inhibitory effects on the antitumor activity of the innate and adaptive immune systems, and resistance to
cancer treatment. Among other factors that may influence immune surveillance, constant physical activity appears
to reduce the risk of cancer-related mortality and cardiovascular risk. However, this does not seem to increase
the survival of patients with PDAC. The exception is our young inoperable patient. For LA head PDAC, he was
treated with seven cycles of Nab-PCT-GEM and RT 50 Gy/15 fractions combined to biweekly GEM and salvage
FOLFIRINOX. The five-year surviving patient travelled 15,000 km on foot and continues inexorably his "walking
therapy".

Keywords: Pancreatic adenocarcinoma, depression, physical activity, Nab-paclitaxel, fluorouracil, regulatory T cells,
myeloid-derived suppressor cells

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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