Abstract
RATIONALE: The occurrence of refractory small cell lung cancer (rSCLC) with pancreatic metastasis is a relatively rare clinical condition, which is typically accompanied by a poor prognosis and rapid disease progression. PATIENT CONCERNS: A 65-year-old male farmer from China was diagnosed with limited-stage small cell lung cancer (SCLC) 8 months ago. Following 6 cycles of EP chemotherapy, the patient's tumor response showed partial relief. He discontinued chemotherapy for 2 months and subsequently experienced abdominal pain for 1 month. DIAGNOSES: A computed tomography scan revealed a malignant tumor in the lower lobe of the right lung, as well as low vascular nodules in the pancreas, which are suspected to be metastases. Laboratory tests indicated elevated levels of amylase and lipase, along with abnormalities in 5 indicators associated with lung cancer. INTERVENTIONS: Upon admission, the patient received active treatment for pancreatitis. Given the progression of the tumor, salvage chemotherapy was initiated, combining albumin with paclitaxel and attilizumab, in consultation with a multidisciplinary team (MDT). OUTCOMES: Abdominal pain was significantly reduced, and levels of amylase and lipase returned to normal, while neuron-specific enolase levels decreased. However, during subsequent follow-up, enlarged pancreatic lesions were identified, necessitating a reevaluation of treatment strategies. LESSONS: This case study highlights the challenges associated with treating rSCLC that has metastasized to the pancreas. Although targeted therapy for metastasis-induced pancreatitis and systemic chemotherapy can alleviate symptoms and enhance patients' quality of life, continuous monitoring and optimization of treatment plans are essential for managing this aggressive disease. The findings emphasize the importance of a multidisciplinary approach in diagnosing and treating such complex cases, underscoring the necessity for personalized treatment strategies to address both the primary cancer and its metastatic complications.