How would you treat an elderly patient with biopsy proven extensive non-resectable metastatic pseudopapillary pancreatic tumor?

This response is for cases that curative surgery or debulking surgery is not an option. These patients may respond to targeted therapy or hormonal therapy. We perform genomic profiling. If alterations are present which lead to the activation of PI3K/AKT/mTOR pathway, we use everolimus or temsirolimus. In an elderly patient, we start with half of the dose and adjust per tolerance. It is also worthwhile performing Estrogen Receptor (ER) and Progestin Receptor (PR) immunohistochemistry. Some of the pseudopapillary tumors respond to hormonal therapy such as tamoxifen. In summary, it might be worthwhile to perform genomic profiling, and IHC for ER and PR. If a molecular tumor board is available, a discussion of these cases in the molecular tumor...