Fig. 4. Illustrative case #18 (see Table 2).

Sixty-four-year-old woman with pancreatic cancer with KRAS G12D, KRAS G12R, CDKN2A loss exons 1–2, CDKN2B loss, SMAD4 deletion exon 11, TP53 R267W on tissue NGS treated with palbociclib (targets CDK4/6 upregulated by CDKN2A/B loss), trametinib (targets MEK, upregulated by KRAS and SMAD4 mutations), and bevacizumab (targets VEGF, upregulated by TP53 mutations). There were no serious drug-related side effects. She achieved partial response with PFS of 17.5 months. Patient died from complications of a chronic obstructive pulmonary disease exacerbation, which was felt to be unrelated to her cancer or her therapy. At the time of death, patient was free from progression. a Serial CT scans of primary pancreatic mass. b CA-19-9 trend on therapy (reference range, 30–42 U/mL).