79 year woman very complex medical history including cardiac arrest after hernia repair surgery last year presented with jaundice found to have a pancreatic mass 2.4 x2.6 cm FNA positive for adenocarcinoma, brushings from the biliary tree also positive for adenocarcinoma. PET-CT negative for any metastatic disease. She is not interested in undergoing a Whipple but interested in receiving other forms of treatment. How would you approach this case? Would you offer neoadjuvant gemcitabine abraxane followed by RT?
Yes, your approach is reasonable. Is there involvement of SMV, SMA? regardless, we face a similar scenario often, and patients who do well with neoadjuvant gem/abraxane +- RT, do change their mind about surgery as the neoadjuvant approach is test of both biology and tolerability. If they do not go for surgery, it buys time for local control. Complete NGS and Germline for this patient as well.