Neoadjuvant Chemotherapy after Plasmapheresis in Borderline Resectable Pancreatic Cancer: A Case Report.

Introduction: Persistent jaundice may occasionally occur even after technically successful biliary drainage, posing a considerable challenge in patients requiring early systemic therapy. In borderline resectable pancreatic cancer (BR-PC), timely initiation of neoadjuvant chemotherapy (NAC) is critical for optimizing treatment outcomes, but hyperbilirubinemia often delays therapy. Although plasmapheresis has been reported as a potential option for refractory hyperbilirubinemia, its use for facilitating initiation of NAC in BR-PC has not been well described. Case Presentation: We present a case of a 65-year-old man with BR-PC who underwent endoscopic biliary drainage with metallic stent placement. Despite successful drainage, his serum bilirubin concentrations remained markedly elevated, preventing initiation of NAC. Plasmapheresis was performed, which resulted in a steady decline in bilirubin concentrations and allowed NAC with gemcitabine plus nab-paclitaxel to begin 21 days after plasmapheresis. There was no recurrence of jaundice during treatment, NAC was completed without interruption, and pancreaticoduodenectomy was subsequently performed. Conclusion: This case highlights the potential role of plasmapheresis as an adjunctive strategy in managing persistent jaundice following biliary drainage, particularly when early induction of chemotherapy is required in patients with BR-PC.