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A woman in her 60s developed stage IV pancreatic tail cancer with multiple liver metastases and stage I left breast cancer, achieving sustained partial response to SOXIRI. After BRCA1-pathogenic testing, maintenance olaparib enabled durable stabilization, then breast-conserving surgery occurred 28 months after treatment initiation, with long-term survival and no progression.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/adaptive-surgical-decision-making-for-synchronous-metastatic-pancreatic-cancer-and-early-breast-cancer-with-a-brca1-pathogenic-variant-a-case-report/357845/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/adaptive-surgical-decision-making-for-synchronous-metastatic-pancreatic-cancer-and-early-breast-cancer-with-a-brca1-pathogenic-variant-a-case-report/357845.png","ImageObject",300,407,{"name":92,"@type":93},"PakDamar76","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is optimal timing of surgery challenging in this case?","Question",{"text":112,"@type":113},"Because synchronous malignancies include a dominant stage IV pancreatic cancer, requiring adaptive reassessment of oncologic priority to coordinate treatment without compromising long-term prognosis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What treatment sequence was used before breast surgery?",{"text":117,"@type":113},"The patient received SOXIRI for metastatic pancreatic cancer, followed by maintenance olaparib after identifying a BRCA1 pathogenic variant, resulting in durable systemic control.",{"name":119,"@type":110,"acceptedAnswer":120},"When was breast-conserving surgery performed, and what was the outcome?",{"text":121,"@type":113},"Breast-conserving surgery with level II axillary lymph node dissection was performed 28 months after treatment initiation, and at 77 months the patient remained alive without breast cancer recurrence or pancreatic progression.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},357845,1790709663,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","SURGICAL CASE REPORTS Surg Case Rep 2026; 12: 26-0257  \nCase Report  \nAdaptive Surgical Decision-Making for Synchronous Metastatic Pancreatic Cancer and Early Breast Cancer with a BRCA1 Pathogenic Variant:  \nA Case Report  \nTakahiro Akahori ,1 Tomoyo Yokotani,1 Akihiko Yoshizawa,2 Tomoko Uchiyama,2  \nRyo Yamaguchi,2 and Masayuki Sho1  \nABSTRACT  \nINTRODUCTION: Synchronous pancreatic and breast cancers associated with a breast cancer susceptibility gene (BRCA)1 pathogenic variant are extremely rare. When 1 malignancy presents as stage IV disease, determining the optimal timing and extent of surgical intervention for a second primary cancer represents a major clinical challenge.  \nCASE PRESENTATION: A woman in her 60s was diagnosed with synchronous stage IV pancreatic tail cancer with multiple liver metastases and stage I left breast cancer. S-1/oxaliplatin/irinotecan (SOXIRI) was initiated for metastatic pancreatic cancer, achieving a sustained partial response. Germline testing revealed a BRCA1 pathogenic variant. Maintenance olaparib was subsequently introduced, resulting in durable disease stabilization and normalization of tumor markers. While the pancreatic cancer remained controlled, the breast cancer progressed with axillary lymph node involvement. After confirming long-term systemic stability and preserved performance status, breast-conserving surgery with level II axillary lymph node dissection was performed 28 months after treatment initiation. At 77 months, the patient remains alive without breast cancer recurrence or pancreatic cancer progression.  \nCONCLUSIONS: Adaptive surgical decision-making for a concurrent operable malignancy, supported by durable systemic control of a dominant stage IV cancer, may help prevent the malignancy from becoming an additional threat to long-term prognosis. Dynamic reassessment of oncologic priority is essential in the era of molecularly targeted therapy.  \nKEYWORDS: breast neoplasms, pancreatic neoplasms, BRCA1 protein, neoplasms, multiple primary, poly(ADP-ribose) polymerase inhibitors  \nAbbreviations  \nBRCA breast cancer susceptibility gene CA19-9 carbohydrate antigen 19-9  \n1Department of Surgery, Nara Medical University, Kashihara, Nara, Japan  \n2Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan  \nCorresponding author: Takahiro Akahori. Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan  \nE-mail: [akahorin@naramed-u.ac.jp](akahorin@naramed-u.ac.jp)  \nReceived: April 2, 2026; Accepted: July 23, 2026  \nDOI: 10.70352/scrj.cr.26-0257  \nCEA carcinoembryonic antigen  \nER estrogen receptor  \nHRD homologous recombination deficiency  \nIRIS irinotecan and S-1  \nPARP poly (ADP-ribose) polymerase  \nSEER Surveillance, Epidemiology, and End Results SOXIRI S-1/oxaliplatin/irinotecan  \nINTRODUCTION  \nHereditary breast and ovarian cancer syndrome caused by germline pathogenic variants in breast cancer susceptibility genes BRCA1 or BRCA2 increases the lifetime risk of breast, ovarian, and pancreatic cancers.1,2) Platinum-based  \n© 2026 The Author(s) . Published by Japan Surgical Society  \nThis article is licensed under a Creative Commons Attribution 4.0 International License.  \nAkahori T. et al.  \nFig. 1 CT images. (A) Abdominal contrast-enhanced CT revealed a low-density mass occupying the entire pancreatic tail (white arrow) and multiple low-density masses in the liver (white arrows) . (B) A 1. 5-cm contrast-enhancing mass was identified in the lower inner quadrant of the left breast (white arrowhead) .  \nchemotherapy and PARP inhibitors have improved outcomes in selected patients with BRCA-associated metastatic pancreatic cancer.3,4) Olaparib has also demonstrated efficacy in germline BRCA-mutated metastatic breast cancer.5) However, when synchronous BRCAassociated malignancies include stage IV disease, there are no established guidelines for treatment prioritization, optimal timing of surgical intervention for the c","cbCaibGjUyBkgJZM","https://ap.wps.com/l/cbCaibGjUyBkgJZM","pdf",2246329,"English","# Abstract\n# Introduction\n# Case Presentation\n# Conclusions\n# Key Clinical Data","[{\"question\":\"Why is optimal timing of surgery challenging in this case?\",\"answer\":\"Because synchronous malignancies include a dominant stage IV pancreatic cancer, requiring adaptive reassessment of oncologic priority to coordinate treatment without compromising long-term prognosis.\"},{\"question\":\"What treatment sequence was used before breast surgery?\",\"answer\":\"The patient received SOXIRI for metastatic pancreatic cancer, followed by maintenance olaparib after identifying a BRCA1 pathogenic variant, resulting in durable systemic control.\"},{\"question\":\"When was breast-conserving surgery performed, and what was the outcome?\",\"answer\":\"Breast-conserving surgery with level II axillary lymph node dissection was performed 28 months after treatment initiation, and at 77 months the patient remained alive without breast cancer recurrence or pancreatic progression.\"}]","Adaptive Surgical Decision-Making for Synchronous Metastatic Pancreatic Cancer and Early Breast Cancer with a BRCA1 Pathogenic Variant - A Case Report | PDF",1790132052,15]