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Background: The incidence of venous thromboembolism(VTE) in cancer patients is high and has been increasing. VTEs affect patients' quality of lives and sometimes can be the cause of death. Heparin is thought to be more effective than other anticoagulants, and few evidence particularly in cancer patients have clearly shown effectiveness of DOACs, which are much easier to be given. Now we report a case of pancreatic cancer, in which pulmonary embolism(PE) and non-bacterial thrombotic endocarditis(NBTE) simultaneously occurred during DOAC therapy after withdrawal from chemotherapy. Case A woman in her eighties, who had pancreatic cancer with multiple liver metastases, underwent chemotherapy with S-1 since April 201X. US showed a thrombosis in central soleal vein of her left lower limb, and she started treatment with edoxaban 30mg a day. CT scan in October demonstrated progression of the cancer, and chemotherapy were discontinued on November 21st. She was admitted on December 29th, and chest back pain and signs of hypoxemia revealed on December 30th. CT scan showed PE and ultrasound cardiography showed moderate pulmonary hypertension and signs of NBTE with moderate aortic valve regurgitation. Unfractionated heparin(UFH) treatment gradually improved pain and hypoxemia, without recurrence of VTEs until her death of pancreatic cancer on February 21st 201Xþ1. Conclusion:We experienced a case of PE and NBTE in pancreatic cancer patient, which is refractory to edoxaban, and UFH treatment was thought to be successful. P3 À 085 A case of recurrent pancreatic cancer diagnosed with skull metastasis in dysphagia / diplopia and treated Kazutaka IijimaDepartment of Oncology=Gastroenterology, Ibaraki Prefectural Central Hospital=Ibaraki Prefecture Regional Cancer Center A 51-year-old female case.Total pancreatectomy (pT3N1M0 stage III) was performed for pancreatic head/pancreatic tail cancers at 49 years old, and postoperative adjuvant chemotherapy was performed. Multiple lymph node metastasis appeared in the vertical contour, subclavian, para-aortic periportal region, and inguinal region at 1 year and 6 months after surgery, and chemotherapy (FOLFIRINOX) was started. After the chemotherapy started 6 months after the start of the chemotherapy, since it caused a complex feeling of swallowing and diplopia, CT and MRI scrutinized it and found a multilocular cystic mass within the skull base bone. Diagnosis of dysphagia and diplopia was diagnosed as abduction nerve paralysis due to metastasis of the skull base bone, and stereotactic radiotherapy (47.5 Gy / 19 times) was performed on the bone metastatic lesion. After that, chemotherapy (GEM þ nab-paclitaxel) started, gradually swallowing disorder and multiple vision improved and disappeared. PET-CT after about 4 months did not show accumulation of FDG at the same site, other lymph node metastasis also tended to decrease, chemotherapy is ongoing. Metastasis of pancreatic cancer to the cranial bone is extremely rare and we experienced an example that contributed to improvement of symptom...