Background: Secondary involvement of the uterine cervix by non-gynecological neoplasms is rare, accounting for less than 2% of metastases to the gynecologic tract. Primary pancreatic tumor disseminating to the uterine cervix is even more unusual. Here, we present an interesting case of pancreatic adenocarcinoma with isolated metastasis to the cervix. A high index of suspicion is necessary in such atypical presentations to ensure timely diagnosis and appropriate management. Case Description: A 62-year-old female presented with vaginal bleeding and pelvic pain for 6 months. No relevant medical, surgical, family, or personal history was noted. Clinical examination revealed a cervical growth, and imaging studies identified lesions in both the cervix and pancreas. Immunohistochemistry (IHC) on the cervical biopsy was found to be positive for cytokeratin 7 (CK7), caudal type homeobox 2 (CDX2), and carbohydrate antigen 19-9 (CA19-9), while it was negative for p16, p63 and paired box protein-8 (PAX-8), consistent with metastatic pancreatic adenocarcinoma. The patient first received palliative radiotherapy to the cervical lesion at a dose of 30 Gy in 10 fractions over 2 weeks for symptomatic relief. Subsequently, systemic chemotherapy was initiated with gemcitabine (1,000 mg/m2 on days 1 and 8) and cisplatin (40 mg/m2 on days 1 and 8), repeated every 21 days. She showed a significant clinical and radiographic response after three cycles and was continued with the same therapy, but defaulted after completing five cycles of chemotherapy. Long-term follow-up of the patient is therefore unavailable. Conclusions: This case highlights the importance of prudent histological evaluation to distinguish a metastatic disease from primary cervical lesions. While surgical resection may hold therapeutic potential for such localized metastasis, patient selection and comprehensive evaluation of clinical parameters are of paramount importance for informed decision-making and tailored management approaches. Recognizing rare metastatic patterns is essential for accurate diagnosis and optimizing treatment strategies.

Background: Little data exists to guide treatment decisions for patients with metastatic pancreatic adenocarcinoma (MPA) after disease progression on FOLFIRINOX during first-line. We set out to describe the outcomes of patients treated with gemcitabine plus nab-paclitaxel (GnP) in this setting. Methods: This is a single-center retrospective cohort study conducted at A.C. Camargo Cancer Center. We included patients with MPA who received GnP in second-line after progression on FOLFIRINOX from 2015 to 2022. Additionally, in an exploratory analysis, we compared the outcomes of patients treated with GnP and those treated with single-agent gemcitabine in a previous publication from our group. Radiological response evaluation was carried out every 2 to 3 months with abdominal computed tomography (CT) or magnetic resonance imaging and chest CT. Survival curves were generated using the Kaplan-Meier method and compared between groups using the log-rank test. Results: The study population consists of 29 patients. The overall response rate (ORR) was 17.2% and the disease control rate (DCR) was 48.3%. The median progression-free survival (mPFS) was 3.7 months [95% confidence interval (CI): 2.5–5.3] and the median overall survival (mOS) was 5.6 months (95% CI: 4.3–12.6). In the exploratory analysis, GnP was associated with numerically higher ORR (17.2% vs. 0.0%; P=0.053) and DCR (48.3% vs. 23.1%; P=0.10) compared with gemcitabine. The mPFS favored GnP [3.7 months (95% CI: 2.5–5.3) vs. 2.3 months (95% CI: 1.9–2.7); P=0.007] and there was a numerical increase in mOS in the GnP arm [5.6 months (95% CI: 4.3–12.6) vs. 4.5 months (95% CI: 3.3–7.7); P=0.11]. GnP was associated with an increased frequency of grades 3 or higher anemia (21.4% vs. 0.0%; P=0.02) and a trend toward more grades 3 or higher thrombocytopenia (27.6% vs. 12.0%; P=0.19). Conclusions: Treatment with GnP leads to modest clinical benefit in second-line. GnP seems to be associated with improved clinical activity compared with single-agent gemcitabine, albeit with higher rates of hematological toxicity.