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Lo Re et al. J Cancer Metastasis Treat 2019;5:81 I http://dx.doi.org/10.20517/2394-4722.2019.30 Page 3 of 8

A B

C D

E F

Figure 1. A: Computed tomography (CT) scan before Nab-paclitaxel-Gemcitabine therapy: hypodense lesion of 30 mm maximum
transverse diameter, infiltrating the posterior lamina and presenting contact with the superior mesenteric artery; B: Wirsung duct
dilatation of 8.42 mm; C: CT scan after Nab-paclitaxel-Gemcitabine therapy and consolidation radiotherapy: volumetric stability of
the pancreatic lesion (29.76 mm); D: the Wirsung duct caliber (7.99 mm); E: 63 months from start therapy (after Nab-paclitaxel-
Gemcitabine, radiotherapy and FOLFIRINOX salvage therapy) presence of slight reduction of the pancreatic lesion (25.38 mm maximum
transverse diameter); and F: increase of the Wirsung caliber (10.67 mm) with atrophy of the pancreas body and tail

The hematological study has documented a count reduction of lymphocytes and platelets during chemo-
radiotherapy followed by stabilization [Figure 2A]. Regarding the immune profile of lymphocyte
subpopulations, a progressive reduction of CD3, CD4, and CD8 followed by an increase; a wave trend of
CD16; and stability of HLA-DR and Treg were reported.

Moreover, after initial reduction of platelet/lymphocyte ratio followed by stabilization during therapy, an
initial temporary increase tending to a fair final reduction after start of physical exercise was reported [Figure
2B and C]. Furthermore, after a decrease of Ca19.9 [Figure 2E] and C-reactive protein (CRP) and increase
of albumin [Figure 2D], the stability over time of its level, as well as those of the other indexes of illness
such as albumin [Figure 2D], CEA, and Ca19.9 [Figure 2E], was observed.

DISCUSSION
Current treatments for advanced PDAC represented by Nab-PCT-GEM and FOLFIRINOX combinations
have improved prognosis and survival, which remain poor.

In addition to the aforementioned factors of a local nature, other factors of an immunological nature
contribute to resistance to cytoreductive drugs and ultimately to neoplastic progression.