A case report of advanced pancreatic cancer patient demonstrating remarkable efficacy with liposomal irinotecan after failure of multiple-line therapies.

Pancreatic cancer remains one of the most aggressive malignancies with an exceptionally poor prognosis. We herein report a case of a 53-year-old male diagnosed with pancreatic tail adenocarcinoma accompanied by extensive hepatic metastases. Despite receiving standard first-line FOLFIRINOX chemotherapy, the patient demonstrated progressive disease accompanied by severe anemia and persistently elevated tumor markers. Subsequent second-line therapy combining gemcitabine/nab-paclitaxel (GA regimen) failed to achieve disease control. Third-line treatment employing lenvatinib plus sintilimab (an anti-PD-1 immune checkpoint inhibitor) similarly resulted in disease progression (PD, Progressive Disease). Remarkably, after transitioning to Nal-IRI-based therapy, the patient achieved a durable partial response (PR) sustained for 10 months (Progression-Free Survival, PFS = 10 months) with favorable tolerability. In this challenging case of irinotican-resistant pancreatic cancer involving both hepatic and multiple osseous metastases, Nal-IRI demonstrated exceptional clinical activity as a later line therapeutic intervention, maintaining disease control for nearly one year with manageable toxicity. These observations suggest that Nal-IRI may represent a viable later line treatment strategy for advanced irinotican-resistant pancreatic cancer, warranting further investigation through prospective clinical trials.