All surgical Caspase inhibitor margins were negative for carcinoma. The patient recovered well from the procedure and was discharged to home on postoperative day six. Due to the positive margin and tumor stage, adjuvant gemcitabine was considered (3). After a literature review of available case reports, the risks of teratogenicity and preterm labor while receiving gemcitabine were

approached with the patient and her family. She was willing to proceed. She received two cycles of gemcitabine (1000 mg/m2) beginning Inhibitors,research,lifescience,medical her 24th week of pregnancy, until her 31st week. She tolerated chemotherapy well without significant myelosuppression. Chemotherapy was administered on an inpatient basis to facilitate fetal monitoring; no adverse fetal effects were Inhibitors,research,lifescience,medical seen during the pregnancy. After a period of washout from her chemotherapy to minimize the risk of thrombocytopenia in the infant and mother, labor was induced

at 35 weeks and delivered a male infant (4 pounds 9 ounces) with APGAR scores of 8 and 9 and blood counts that were within normal limits. The patient Inhibitors,research,lifescience,medical and her baby were monitored in the hospital and discharged home 6 days after delivery. Given the prolonged period of time off of chemotherapy, restaging was performed prior to reinitiating chemotherapy in an adjuvant strategy. Two weeks after delivery, and 6 weeks off chemotherapy, CT scans demonstrated multiple low attenuation lesions within the liver (largest 1.4 cm), as well as enlarged mesenteric, aortocaval, and peripancreatic lymph nodes. With the evidence of recurrence, she was started on a salvage regimen including capecitabine 1000 mg/m2 po BID days 1-14, gemcitabine 750 mg/m2 days 4 and 11, and docetaxel 30 mg/m2 day 1 and 14. She enrolled on a series of clinical trials and Inhibitors,research,lifescience,medical subsequently received many different chemotherapy regimens but never achieved a durable response. She died 12 months after diagnosis. The patient’s child Inhibitors,research,lifescience,medical has met all appropriate developmental milestones in terms of growth, cognitive development, language development,

and socialization. He has a functionally intact immune system. He is now nearly two years old. Discussion Other case reports of administration of chemotherapy in pregnancy have been reported, as SB-3CT have cases of pancreatic cancer treated surgically in pregnant patients (described below). We report this case of pancreatic cancer in a pregnant woman who underwent surgical exploration and adjuvant chemotherapy, which we believe to be the first case in the literature. For her staging, the patient underwent a non-contrast MRI given theoretical concerns for fetal exposure to gadolinium based contrast agents. Based on pre-clinical data, animal data, as well as incidental administration to pregnant patients, the ACR recommends against the use of gadolinium contrast agents in pregnancy, and recommends written informed consent disclosing risks and benefits (1).