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Though Pancreatic Cancer may be Resistant to Immunotherapy from Immune Checkpoint Inhibitors, it may be Sensitive to Blocking the Production of Immunoprotective Proteins Unique to Pregnancy
Case Report
Though Pancreatic Cancer may be Resistant to Immunotherapy from Immune Checkpoint Inhibitors, it may be Sensitive to Blocking the Production of Immunoprotective Proteins Unique to Pregnancy
Objective: Pancreatic cancer does not respond to immune checkpoint inhibitors, and therefore, it is considered a cancer that is not immunosensitive. However, even though pancreatic cancer may not produce the programmed cell death protein ligand 1 (PD-L1), it may produce immunomodulatory proteins, e.g., the progesterone-induced blocking factor (PIBF) produced by activating membrane progesterone receptors. If so, inhibition of pancreatic cancer regression and/or tumor regression may be found following treatment with a progesterone receptor modulator, e.g., mifepristone.
Methods: Mifepristone 200 mg orally daily was given to a terminal 83-year-old patient suffering from stage IV pancreatic cancer with jaundice related to bile duct destruction, mid-epigastric pain, anorexia, and marked weakness.
Results: Within 3 weeks, the jaundice was no longer present, and her pain, anorexia, fatigue, and cognition markedly improved. Unfortunately, she slipped in the shower and broke her nose and ribs. The hospital refused to allow her to take the Mifepristone because it was off-label. The cancer aggressively returned after being without mifepristone therapy for 2.5 weeks.
Conclusion: This was the second case showing marked palliative benefits to well-tolerated mifepristone. It is also the second case shown that the cancer will resume active spread if the drug is stopped for more than a week.
