Integrative Palliative Management of Metastatic Pancreatic and Esophageal Carcinoma: A Case Report on Synergistic Ayurvedic Adjuvant Therapy

Background

Advanced metastatic pancreatic carcinoma presenting with dual primary or secondary malignancies, such as esophageal involvement, carries an extremely poor prognosis. Standard cytotoxic chemotherapy regimens like FOLFIRINOX often cause severe treatment-related toxicities, leading to high discontinuation rates and compromised quality of life. Integrating evidence-based Ayurvedic formulations as adjuvant palliative care can mitigate chemotherapy-induced side effects, improve treatment tolerance, enhance anabolic/cytoprotective pathways, and support overall clinical response. Case Presentation: A 55-year-old female presented with jaundice (scleral icterus), severe abdominal pain, loss of appetite, anorexia, nausea, significant weight loss, and marked weakness. Diagnostic PET-CT revealed a hypermetabolic mass in the head of the pancreas with distant metastases and an esophageal nodular lesion. Laboratory evaluation demonstrated obstructive jaundice (Total Bilirubin: 12 mg/dL; Direct Bilirubin: 8 mg/dL; Indirect Bilirubin: 4 mg/dL) and elevated CA 19-9 tumor markers. Histopathological examination confirmed pancreatic carcinoma. Biliary decompression was successfully achieved via Upper GI Endoscopic Common Bile Duct (CBD) stenting. The patient was initiated on first-line palliative FOLFIRINOX chemotherapy (2 cycles), which was discontinued due to severe grade 3/4 toxicities, including intractable vomiting, diarrhea, headache, and giddiness. Treatment was switched to Gemcitabine plus Nab-Paclitaxel (2 cycles, weekly). Concurrently, an Ayurvedic integrative protocol—comprising Shatavari, Sutshekhar Ras, Shankh Vati, and Chardiripu Ras—was introduced as an adjuvant Rasayana (restorative/cytoprotective) and palliative regimen aimed at targeting the affected Doshas and Dhatus.