Case Presentation: Assessing Opportunities for Targeted Therapy in Suspected Metastatic Pancreatic Cancer
Patient Case:
This patient is a 65-year-old male with a past medical history significant only for hypertension who presented for medical oncology consultation as a second opinion after recently being diagnosed with metastatic adenocarcinoma.
He initially sought medical attention for a persistent non-productive cough that had been present for several weeks. He otherwise reported a decline in energy over the past 2–3 months, mild unintentional weight loss, and reduced appetite, but denied hemoptysis, fevers, or significant abdominal pain. He has remained independent in his activities of daily living.
Initial imaging performed at an outside health system demonstrated widespread bilateral pulmonary metastatic lesions as well as a mass in the tail of the pancreas, concerning for a pancreatic primary with metastatic disease. He subsequently underwent an interventional radiology-guided biopsy of a lung lesion.
Pathology showed adenocarcinoma, with immunohistochemistry notable for CK7 positivity, interpreted as being most consistent with an upper gastrointestinal or hepatobiliary primary. In the context of the pancreatic tail mass seen on imaging, the working diagnosis at the time of consultation was metastatic adenocarcinoma, likely pancreatic in origin.
He presented to our office accompanied by his spouse for a second opinion regarding diagnosis, prognosis, and treatment options. He is particularly interested in targeted therapy, specifically whether he may be a candidate for a RAS inhibitor and asks about the role of comprehensive genomic profiling to identify actionable.
He is eager to understand whether additional molecular testing, pathology review, or repeat biopsy would help guide treatment selection. He also asks how disease would be measured in terms of repeat imaging and blood tests to know if the treatment is working.
