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. Results: Adjuvant Ayurvedic therapy significantly ameliorated chemotherapy-induced side effects, preventing severe mucositis, intractable diarrhea, and emesis. The patient demonstrated improved treatment tolerance, improved appetite, weight stabilization, and enhanced general well-being (Ojovardhana). Follow-up evaluations demonstrated a marked decline in CA 19-9 tumor marker levels alongside sustained disease control. Conclusion: Co-administration of targeted Ayurvedic formulations alongside second-line palliative chemotherapy served as a safe, effective cytoprotective, antioxidant, and anabolic adjuvant strategy. This holistic, integrative approach facilitated full therapeutic adherence and favorable tumor marker response in a patient with complex metastatic gastrointestinal malignancy.