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Pancreatic Cancer Case Studies

Case Studies: Advancing Outcomes in Metastatic Pancreatic Cancer

George Kim, MD, reviews the diagnosis and treatment of a 57-year-old male who presents with unresectable metastatic pancreatic adenocarcinoma.

Advancing Outcomes in Metastatic Pancreatic Cancer

A 57-Year-Old Man With Abdominal Pain and Unexplained Weight Loss

  • A 57-year-old man was referred from his primary care clinician with complaints of persistent pain in his upper abdomen that radiate to his back
  • History
    • Former smoker (35 years, quit 5 years ago)
    • Was obese (BMI 29.0), but began losing weight despite not changing his eating habits
    • Reports feeling “tired” despite regular sleep habits
    • Treated for DVT 8 months ago
    • Hypertension controlled on medication, impaired glucose tolerance
    • Family history: mother alive with type 2 diabetes, father died (MI)
  • Clinical evaluation
    • CT reveals mass in head of pancreas with metastases in liver and blood vessels
    • CA19-9 level: 55 times upper limit of normal
    • ECOG PS: 1
  • Diagnosis: unresectable metastatic pancreatic cancer
  • Patient began treatment with IV nab-paclitaxel (125 mg/m2) plus IV gemcitabine (1000 mg/m2) on days 1, 8 and 15 of a 28-day cycle
    • Experienced grade 3 neutropenia; did not require growth factors
    • Had mild peripheral neuropathy that did not progress or require dose adjustment
  • At 6 months, patient progressed and received second-line treatment with liposomal irinotecan in combination with 5-FU/LV
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