Macroscopic and histologic regression of duodenal polyposis with FOLFOX4 chemotherapy for an ileal pouch adenocarcinoma in a patient with familial adenomatous polyposis

Severe (stage IV) duodenal polyposis is difficult to manage in patients with familial adenomatous polyposis (FAP), with no effective medical treatment, complex endoscopic treatment modalities, and a high morbidity and mortality from pancreaticoduodenectomy. We present the case of a 44-year-old woman with FAP, stage IV duodenal polyposis, and with an ileal pouch adenocarcinoma that required surgery and adjuvant chemotherapy. Her duodenal polyposis regressed to stage II after four sessions of FOLFOX4 adjuvant chemotherapy, which avoided the need for aggressive endoscopic therapy or pancreatoduodenectomy in this patient.

• References

• 1 Jarvinen H, Nyberg M, Peltokallio P. Upper gastrointestinal tract polyps in familial adenomatosis coli. Gut 1983; 24: 333-339
• 2 Gallagher MC, Phillips RK, Bulow S. Surveillance and management of upper gastrointestinal disease in familial adenomatous polyposis. Fam Cancer 2006; 5: 263-273
• 3 Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1988; 1: 1149-1151
• 4 Saurin JC, Gutknecht C, Napoleon B et al. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. J Clin Oncol 2004; 22: 493-498
• 5 Bulow S. Results of national registration of familial adenomatous polyposis. Gut 2003; 52: 742-746
• 6 Heiskanen I, Kellokumpu I, Jarvinen H. Management of duodenal adenomas in 98 patients with familial adenomatous polyposis. Endoscopy 1999; 31: 412-416
• 7 Spigelman AD, Williams CB, Talbot IC et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
• 8 Richard CS, Berk T, Bapat BV et al. Sulindac for periampullary polyps in FAP patients. Int J Colorectal Dis 1997; 12: 14-18
• 9 Phillips RK, Wallace MH, Lynch PM et al. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut 2002; 50: 857-860
• 10 Cote GA, Brunt EM, Jonnalagadda SS. Familial adenomatous polyposis-associated ampullary adenoma: response to chemotherapy for concurrent metastatic adenocarcinoma. Clin Gastroenterol Hepatol 2009; 7: e28-e29