Molecular tumor boards in pancreatic cancer with liver metastasis: A case report

Pancreatic cancer has limited treatment options and poor prognosis owing to late diagnosis and aggressive biology. Current therapies include surgery, chemotherapy, and radiation; however, the outcomes remain suboptimal. Molecular tumor boards (MTB) enhance personalized treatment by analyzing genomic data to identify targetable mutations and recommend precise therapies.

A 45-year-old male presented with jaundice in December 2022. Initial investigations revealed a pancreatic head mass and liver metastases; a liver biopsy confirmed moderately differentiated adenocarcinoma. The patient received multimodal therapies, including gemcitabine, albumin-bound paclitaxel, nimotuzumab, and proton radiotherapy, which initially resulted in significant shrinkage of the pancreatic lesion and a reduction in liver metastases. However, the disease eventually progressed, prompting further evaluation at our MTB clinic. Genetic testing revealed a homologous recombination deficiency (HRD) score of 58 (HRD-positive) and a pathogenic BRCA2 mutation (p.T3033fs), suggesting sensitivity to PARP inhibitors and platinum-based therapies. Based on these findings, the patient was administered olaparib, which, combined with immunotherapy (tislelizumab, atezolizumab) and hepatic arterial infusion chemotherapy (5-fluorouracil + leucovorin + oxaliplatin regimen), led to further stabilization and partial reduction of liver metastases. This case underscores the positive role of the MTB model in interpreting genetic profiles and guiding personalized treatment strategies for such patients.

The patient's clinical course highlights the potential of MTB in providing significant benefits for advanced pancreatic cancer with liver metastases.