Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery. The prognosis of borderline resectable pancreatic cancer is even worse.

Dr Al-Sukhun discusses a case report where a 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, fine needle aspiration confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy.

Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis.

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