Supplementary Material for: Metastatic pancreatic adenocarcinoma downstaged to T0N0 with chemotherapy and targeted therapy, confirmed by surgical pathology—A case report.

Introduction:
Pancreatic ductal adenocarcinoma (PDAC) is one of the aggressive human tumors, typically diagnosed at a later stage when surgery is not possible.
Case Presentation:
We report a 62-year-old woman who presented with abdominal pain at her emergency department. CT scan revealed a solitary hepatic lesion and a pancreatic body lesion. The pancreatic body lesion was biopsied endoscopically, and a tissue diagnosis was obtained to confirm her diagnosis of pancreatic ductal adenocarcinoma (PDAC). She was then treated with 12 cycles of FOLFIRINOX with stable disease on CT. Due to history of a hepatic lesion, she then received 11 cycles of gemcitabine/Abraxane and a combination of a MEK inhibitor, Mekinist, and a BRAF inhibitor, BRAFTOVI. Following this, the patient underwent a liver biopsy. The biopsy was negative, and she was deemed resectable. The patient underwent a distal pancreatectomy. Surgical pathology demonstrated a 1.1cm low-grade papillary mucinous neoplasm with negative margins and lymph nodes, staged T0N0. No adjuvant chemotherapy was administered.
Conclusion:
This is the first report of a patient with metastatic pancreatic adenocarcinoma, who has received prolonged IV and oral chemotherapy. At the time of her operation, her pathological stage was T0N0.