1. Pancreatic Cancer CASE 3 Dieter Köberle

2. Case Report 3 69-year old patient received 9 months of postoperative ( ? palliative ?) chemo following R1 resection of a PC pT3 pN1 cM0 During chemo he developed severe complications (near-terminal renal insufficancy, capillary leak syndrome) 8 months after cessation of chemo, a single hepatic metastasis appeared

3. Q & A Should we offer chemotherapy to this patient with severe co-morbidity and near-terminal renal failure after failure of adjuvant chemo for treatment of advanced disease ? Is there a standard first-line treatment after adjuvant GEM ? Is there a standard second-line treatment in GEM-refractory patients ? Should we offer this patient a local treatment (RFA, Resection, SIRS...) ?...and if yes, has this intervention a curative dimension ?  NO  No, I would treat again with GEM or GEM-Combi after PFS of > 6 months  Debatable, there are data from a Phase III trial for the OFF regimen (CONCO-3) in good PS patients  Highly controvertial issue - curative potencial is close to 0% Review of 103 published cases demonstrate mOS of 6-11 months Michalski CW et al: Resection of primary pancreatic cancer and liver metastasis: a systematic review. Dig Surg. 2008;25(6):473-80