A case of long-term survival in unresectable pancreatic cancer with BRCA germline mutation treated with platinum-based chemotherapy.

Unresectable pancreatic cancer has the lowest 5 year relative survival rate among all cancers, at approximately 10%. Standard treatments are often limited because of severe toxicities, and therefore long-term treatment is challenging. We report a case of unresectable pancreatic cancer with a BRCA gene mutation achieving long-term survival through modified FOLFIRINOX (mFFX) therapy. A 61-year-old male was diagnosed with unresectable pancreatic head cancer, accompanied by liver metastasis and para-aortic lymph node metastasis. Initial treatment with gemcitabine and nab-paclitaxel resulted in progressive disease, prompting a switch to mFFX. The first evaluation of efficacy showed significant shrinkage of both the primary tumor and metastatic lesions, and the second evaluation confirmed a complete response. After BRCA gene testing became eligible for insurance coverage, a BRCA2 gene mutation was identified. The patient continued treatment with drugs except oxaliplatin. Lung metastasis appeared and was treated with local therapy. Seven years have passed since the start of treatment, and the patient continues to receive treatment without significant side effects. We present a case of unresectable pancreatic cancer with a BRCA germline mutation that was treated with a combination treatment and achieved long-term survival.