The patient was a 45 year old female. In November 2020, she found that his skin and sclera were yellow stained, and went to the local hospital to take the magnetic resonance imaging. It was suggested that the internal and external bile ducts of the liver were expanded in stages, combined with pancreatic duct expansion. The widest diameter of the common bile duct was about 1.3 cm. The computed tomography (CT) examination in our hospital showed that the uncinate process of the head of pancreas was an irregular nodule with unclear boundary and infiltrative appearance, accompanied by low-level biliary obstruction. There are multiple lymph nodes in peripancreatic, retroperitoneal, left gastric region, mesenteric root, hilar region and portal space, and the possibility of metastasis is high. Subcapsular nodules in left inner lobe of liver, nature undetermined, alert for metastasis. Blood test showed that alanine transaminase (ALT): 271 U/L, aspartate transaminase (AST): 154 U/L, total bilirubin (TBIL): 92.8 umol/l, direct bilirubin (DBIL): 78.9 umol/l, indirect bilirubin (IBIL): 13.9 umol/l. On December 1, 2020, encoscopic retrograde cholangio-pancreatography (ERCP), nasobiliary drainage tube implantation and endoscopic ultrasound pancreatic biopsy were performed. Pathology showed adenocarcinoma. On December 22, 2020, ERCP and fully covered metal biliary stent implantation were performed. The postoperative laboratory results showed that ALT: 50 U/L, AST: 28 U/L, TBIL: 22.8 umol/l, DBIL: 14.4 umol/l, IBIL: 8.4 umol/l. From December 31, 2020 to May 28, 2021, seven cycles of albumin bound paclitaxel combined with Tegafur regimen were performed (the seventh cycle was single drug Tegafur). The best efficacy was partial remission (PR), and CA19-9 decreased from 7693 U/ml to 18.09 U/ml. Grade I sensory peripheral neuropathy was found. Bone scanning was taken during the treatment (February 23, 2021), the density of lumbar 1 vertebral body increased, and bone metastasis was considered in combination with CT. On July 1, 2021, CT reexamination showed that the nodules in the left lobe of the liver were slightly fuller than before, and the duodenal wall was thicker than before. Continue to take Tegafur for 4 cycles. 25 fractions of radiotherapy for pancreas and L1 vertebral body were given in the external hospital. On October 29, 2021, the CT reexamination of the hospital suggested multiple small nodules in both lungs, and metastasis was considered. CA19-9 rose to 1015 U/ml. It was evaluated as progressive disease (PD). The patient was treated with albumin bound paclitaxel combined with gemcitabine for 2 cycles at the local hospital. During this period, grade III leukopenia and grade I thrombocytopenia occurred. On January 5, 2022, CT reexamination showed that the irregular soft tissue shadow at the uncinate process of the pancreatic head was larger than before, and the maximum cross-section is now about 3.3 cm x 2.0 cm. There were slightly low-density nodules scattered in the liver, which increased and enlarged compared with the previous ones, and the largest one was about 2.2cmx1.7cm. Metastasis was considered. The lesion of lumbar 1 vertebral body was enlarged. Multiple small nodules were found in both lungs, which were increased and enlarged compared with the previous ones. The largest one is about 0.5cm. Metastasis is considered. On January 11, 2022, CT guided liver tumor puncture was performed. Postoperative pathology suggested that moderately differentiated adenocarcinoma infiltration was seen in the liver tissue. In combination with history and morphology, pancreatic origin was considered. The replacement scheme was irinotecan, anlotinib combined with tislelizumab for 1 cycle. CA19-9 was 10625 U/ml. 2022.2.22 Next-Generation Sequencing result from 520 gene panel of liver metastases showed EGFR exon 19 mutation (p.E746_s752 > V), KRAS wild-type, tumor mutation burden (TMB) 2 mutations/Mb (Mb stands for every million bases), microsatellite stability (MSS). Immunohistochemistry showed EGFR/ErbB2 2+, ErbB2 1+. On March 5, 2022, she began to take furmonertinib 80mg every day. On May 25, 2022, CA19-9 decreased to 300 U/ml. CT showed the tumor foci of uncinate process of pancreatic head and liver were smaller than before. Liver abscess occurred during the treatment, which gradually subsided after symptomatic treatment. On July 25, 2022, CA19-9 increased to 1000 U/ml. Imaging showed that multiple nodules in both lungs were partially smaller than before, and some were similar to before. Uneven density shadow of thoracic vertebra, with higher density than before, metastasis is considered. The progression-free survival (PFS) of furmonertinib was 4.7 months ( Figures 1 ,  2 ). On August 2022, the treatment regimen was changed to nimotuzumab, capecitabine combined with oxaliplatin. After 1 cycle, the patient was reexamined due to poor physical condition. CT showed that liver metastases increased and enlarged compared with the previous period, with the largest being about 5.7cm x 3.6cm, suggesting that the effect of nimotuzumab combined with chemotherapy was not good ( Figure 3 ). The patient had no previous medical history. The patient's grandmother had liver cancer and had died, and no genetic tests had been performed.