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Case Report Open Access

Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications

  • Authors:
    • Sheng Yu Wei
    • Wei Yu
    • Qiao Huang
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443000, P.R. China
    Copyright: © Wei et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 503
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    Published online on: September 14, 2026
       https://doi.org/10.3892/ol.2026.15858
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Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive solid malignancies, with a dismal prognosis and a 5‑year overall survival rate of 5‑10%. Owing to the absence of specific symptoms at early stages, the majority of patients are first diagnosed with already locally advanced or metastatic disease. Consequently, such patients are ineligible for curative surgery, resulting in limited therapeutic options and poor outcomes. With advances in molecular profiling and next‑generation sequencing, precision medicine has emerged as an important therapeutic approach for advanced PDAC. Targeted therapies directed against specific molecular alterations, including BRCA1/2, HER2 and KRAS, have demonstrated clinical benefit in selected patient populations. However, current evidence predominantly focuses on single gene alterations. There is a lack of data and consensus regarding the optimal treatment strategies for PDAC harboring concurrent multiple genomic aberrations. In the present report, a rare case of KRAS wild‑type PDAC harboring a somatic EGFR exon 19 deletion‑insertion mutation, a heterozygous germline BRCA1 splice‑site mutation and an additional somatic synonymous TP53 variant identified by molecular testing was documented. The patient developed clinically suspected postoperative recurrence and subsequently achieved durable disease control following individualized exploratory treatment with aumolertinib and olaparib. The present case provides a clinically documented observation of individualized targeted therapy in a rare KRAS wild‑type PDAC molecular context and may help inform future hypothesis‑driven investigations in selected molecularly defined patients. However, further studies are required to clarify the functional relevance of these molecular alterations and the clinical value of this treatment approach in selected patients with molecularly unique PDAC.
View Figures

Figure 1

Preoperative contrast-enhanced
computed tomography findings of the primary pancreatic lesion. (A)
Axial contrast-enhanced CT image showing a hypodense mass-like
lesion in the pancreatic body, measuring ~3.1×2.3 cm. The lesion
demonstrates lower enhancement than the surrounding pancreatic
parenchyma. (B) Axial contrast-enhanced CT image showing atrophy of
the distal pancreatic body and tail, accompanied by dilatation of
the main pancreatic duct. CT, computed tomography.

Figure 2

Low- and high-power histopathological
and immunohistochemical findings of the resected pancreatic tumor.
H&E staining shows irregular glandular structures consisting of
atypical tumor cells with enlarged hyperchromatic nuclei and
visible mitotic figures within a fibrotic/desmoplastic stroma. (A)
Magnification, ×40, (B) magnification, ×100 and (C) magnification,
×200. Immunohistochemical staining shows CK7 positivity (D)
magnification, ×40, (E) magnification, ×100 and (F) magnification,
×200. CK19 positivity (G) magnification, ×40, (H) magnification,
×100 and (I) magnification, ×200, CK20 negativity (J)
magnification, ×40, (K) magnification, ×100 and (L) magnification,
×200. CDX2 negativity (M) magnification, ×40, (N) magnification,
×100 and (O) magnification, ×200. Loss or markedly reduced SMAD4
expression in tumor cells (P) magnification, ×40, (Q)
magnification, ×100 and (R) magnification, ×200. H&E,
hematoxylin and eosin; CK, cytokeratin; CDX2, caudal type homeobox
2; SMAD4, SMAD family member 4.

Figure 3

Imaging findings of suspected
postoperative recurrence and radiological response to targeted
therapy. (A) Contrast-enhanced CT performed in September 2024
revealed an oval soft-tissue lesion located in the portal
vein-superior mesenteric artery space, with a maximal diameter of
~1.90 cm and prominent enhancement, suggesting clinically suspected
locoregional recurrence. (B) Follow-up CT performed in December
2024 demonstrated a reduction in the size of the lesion at the same
site, with the maximal diameter reduced to ~1.63 cm, suggesting
radiological regression of the suspected recurrent lesion after
targeted therapy. CT, computed tomography.
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Copy and paste a formatted citation
Spandidos Publications style
Wei SY, Yu W and Huang Q: Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications. Oncol Lett 32: 503, 2026.
APA
Wei, S.Y., Yu, W., & Huang, Q. (2026). Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications. Oncology Letters, 32, 503. https://doi.org/10.3892/ol.2026.15858
MLA
Wei, S. Y., Yu, W., Huang, Q."Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications". Oncology Letters 32.5 (2026): 503.
Chicago
Wei, S. Y., Yu, W., Huang, Q."Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications". Oncology Letters 32, no. 5 (2026): 503. https://doi.org/10.3892/ol.2026.15858
Copy and paste a formatted citation
x
Spandidos Publications style
Wei SY, Yu W and Huang Q: Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications. Oncol Lett 32: 503, 2026.
APA
Wei, S.Y., Yu, W., & Huang, Q. (2026). Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications. Oncology Letters, 32, 503. https://doi.org/10.3892/ol.2026.15858
MLA
Wei, S. Y., Yu, W., Huang, Q."Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications". Oncology Letters 32.5 (2026): 503.
Chicago
Wei, S. Y., Yu, W., Huang, Q."Concurrent EGFR exon 19 deletion‑insertion and germline BRCA1 alteration in KRAS‑wild‑type pancreatic ductal adenocarcinoma: A case report and review of therapeutic implications". Oncology Letters 32, no. 5 (2026): 503. https://doi.org/10.3892/ol.2026.15858
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