Patient description: The patient is a 57-year-old man with abdominal pain and vomiting. The pain started gradually about 20 hours ago in the epigastric and periumbilical regions, radiating to his back. He drinks around 60 units of alcohol per week and smokes 22 cigarettes per day. He is healthy with no history of allergies or using any medications. His family history is positive for type 2 diabetes (his father and sister). He lives alone and has no children. The abdomen is tender and soft. His bowel sounds are normal. His heart rate is 115/min and blood pressure 110/75 mmHg. The lab results are remarkable for leukocytosis (19.5), urea of 8.5, high CRP (145), high amylase (1200) and Glc level of 15. Cross-sectional imaging was negative for obstructive pancreatitis.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Metastatic or Locally Advanced Malignancies Provision of written informed consent Ability of patient to understand and comply with the protocol for the duration of the study, including treatment and scheduled visits and examinations Diagnosis of a metastatic or locally advanced malignancy Progressive disease At least one measurable lesion that can be accurately assessed at baseline by computed tomography or magnetic resonance imaging and is suitable for repeated assessment Prior administration of at least one standard chemotherapy for primary and/or relapsed malignancy according to current guidelines ECOG Performance Status ≤2 Age ≥18 years, no upper age limit Postmenopausal or evidence of non-childbearing status Female patients of childbearing potential and male patients with partners of childbearing potential who are sexually active must agree to the use of two highly effective forms of contraception. These should be started immediately after signing the informed consent form and continued throughout the period of study treatment plus three months for female and for male patients thereafter  (general) Other malignancy except for study indication within the last 5 years except: adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS), Stage 1, grade 1 endometrial carcinoma, or other malignancies curatively treated with no evidence of disease for ≥5 years Concurrent or previous treatment within 30 days prior to C1D1 in another interventional clinical trial with an investigational anticancer therapy Persistent toxicity (≥Grade 2 according to Common Terminology for Adverse Events (CTCAE) version 5.0) caused by previous cancer therapy, excluding alopecia Clinical signs of active infection (>Grade 2 according to CTCAE version 5.0) History of human immunodeficiency virus (HIV) infection and immunocompromised patients Active Hepatitis A virus infection Active hepatitis B virus (HBV) infection, defined as having a positive hepatitis B surface antigen (HBsAg) test at baseline patients with a past or resolved HBV infection, defined as having a negative HBsAg test and a positive total hepatitis B core antibody (HBcAb) test at baseline , are eligible for the study if active HBV infection is ruled out on the basis of HBV DNA viral load per local guidelines Active hepatitis C virus (HCV) infection, defined as having a positive HCV antibody test at baseline confirmed by a polymerase chain reaction (PCR) positive for HCV RNA Dementia or significant impairment of cognitive state Epilepsy requiring pharmacologic treatment