Can standardized and evidence based plant immunomodulator (rice bran arabinoxylan concentrate) increase the effect of Gemcitabine in a synergistic manner? Case report of a patient with ductal pancreas carcinoma

Abstract

Background: Pancreatic ductal carcinoma is leading cause of cancer mortality. Gemcitabine with nab-Paclitaxel as a standard first line therapy is reporting improved clinical parameters but they are only transient. Immunological observations suggest that in background of this rapid resistance a tumor induced dysregulation of immune balance can also play a role. As it was shown the tumor-induced type-2 innate immune cells activate various inhibitory regulatory cells and growth factors which can diminish both the activity of immune effectors and the immune sensitivity of tumor cells. As it well known, the immune sensitivity related to the MHC class-I chain-related A / B (MICA and MICB) stress molecules on tumor cells which are the ligands of the most important killing activator receptor (NKG2D) on natural killer (NK) cells. Because of the discovery several years ago, that Gemcitabine can enhance the expression of MICA and MICB molecules on tumor cells, its combination with an evidence based immunomodulator has a growing clinical interest. Material and methods: In this case report a patient with metastatic and inoperable pancreas ductal adenocarcinoma is presented who was treated with gemcitabine (1678 mg) and nab-paclitaxel (210 mg) on 1.- 8. -15. days of months given eight cycles. This therapy was regularly combined with 45 mg / kg Biobran /MGN-3 given per oral three times a week which is a standardized rice bran arabinoxylan concentrate. Results : In a now 56 years old patient an inoperable ductal adenocarcinoma (39x46 mm) in caudal part of pancreas with multiplex liver metastases (10-30 mm) was established by CT and biopsy. He was in a nearly terminal stage (having 27 kg decrease in body weight and intensive pains). Three months after the start of the therapy a remission of pancreas tumor (25x38 mm) and in liver metastases average 3-10 mm decreases were established by CT. Seven months later in pancreas a complete remission was found and his liver metastases showed further 3-6 mm decreases. After 10 months these remissions were also established. The patient has not now any complaints and is able to work 100%. Conclusion : The combination of gemcitabine with evidence based and standardized immunomodulators (such as MGN-3) may open new strategies in the tumor therapy.