ONCAlert | 2018 Gastrointestinal Cancers Symposium
Pancreatic Cancer Case Studies

Case Studies: Chemotherapy for Metastatic Pancreatic Cancer

In this case-based interview, George P. Kim, MD, discusses the diagnosis and therapeutic management of a patient with metastatic pancreatic cancer.

Chemotherapy for Metastatic Pancreatic Cancer

March 2016

  • A 63-year-old Caucasian male was admitted to the hospital from the emergency room with symptoms of epigastric pain that radiated toward the back, abdominal distention, vomiting, and jaundice
  • Laboratory tests:
    • Bilirubin and liver enzymes; elevated
    • CBC values WNL
    • Hepatitis B, & C testing, negative
    • CEA: 34.2 ng/mL; CA 19-9 > 12000 U/mL
  • Performance status, 1
  • CT reveals 3.5 cm × 3.7 cm mass in the head of the pancreas and multiple liver nodules; also, indicates an obstruction of the bile duct
  • Ultrasound-guided percutaneous needle biopsy of a liver metastases shows adenocarcinoma histology
  • The patient undergoes biliary stent placement based on endoscopic retrograde cholangiopancreatogram (ERCP) findings
  • Diagnosis: stage IV pancreatic cancer with liver metastasis
  • The patient was started with treatment on gemcitabine and nab-paclitaxel
  • CT with contrast after two treatment cycles showed marked shrinkage of the pancreatic lesion and liver nodules.
  • CT after 6 cycles showed stable disease

November 2016

  • The patient reports symptoms of rapid weight loss, abdominal pain, dark urine, and jaundice; he has declining functional status and is often bedridden
  • Systemic therapy is under consideration
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