A Case of Recurrent Acute Pancreatitis After Gemcitabine + Nab-Paclitaxel and Modified FOLFIRINOX Therapy for Advanced Recurrent Pancreatic Cancer

TL;DR

A patient with advanced pancreatic cancer experienced repeated episodes of acute pancreatitis after two different chemotherapy treatments, raising concerns about drug-induced pancreatitis.

Contribution

This case report highlights the potential risk of acute pancreatitis associated with specific chemotherapy regimens in pancreatic cancer.

Findings

Acute pancreatitis occurred within 24 hours of starting both gemcitabine/nab-paclitaxel and modified FOLFIRINOX therapies.

5-HT3 receptor antagonists, common to both regimens, may have contributed to pancreatitis.

The clinical course of pancreatitis was mild and consistent with drug-induced cases.

Abstract

The incidence of drug-induced acute pancreatitis is an important consideration when developing treatment strategies for patients with pancreatic ductal adenocarcinoma. We report a case of recurrent acute pancreatitis that developed following both gemcitabine plus nab-paclitaxel (GnP) chemotherapy and modified FOLFIRINOX (mFFX) therapy. The clinical stage at initial diagnosis was cT3N1M0 stage IIB pancreatic cancer, with subsequent progression to metastatic disease over approximately 1.5 years. Treatment was prioritized at each stage of disease progression despite the occurrence of acute pancreatitis. Recurrent episodes of acute pancreatitis prompted a change in chemotherapy regimen from GnP to mFFX; however, a single causative agent could not be identified. For both chemotherapy regimens, the onset of acute pancreatitis occurred within 24 hours of treatment initiation, and the clinical course was mild, consistent with previous reports of drug-induced pancreatitis. Agents common to both regimens, specifically 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, may have contributed to the development of pancreatitis. Further accumulation of similar cases is required to better clarify the relationship between pancreatic cancer chemotherapy and the risk of acute pancreatitis.

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