Incidence and computed tomography findings of lenvatinib-induced pancreatobiliary inflammation

Abstract

In this single-center retrospective study, we intended to evaluate the frequencies and characteristics of computed tomography findings of pancreatobiliary inflammation (PBI) in patients treated with lenvatinib and the relationship of these findings with treatment-planning changes. We included 78 patients (mean ± standard deviation, 69.8 ± 9.4 years, range: 39–84 years, 62 men) with hepatocellular carcinoma (n = 62) or thyroid carcinoma (n = 16) who received lenvatinib (June 2016–September 2020). Two radiologists interpreted the posttreatment computed tomography images and assessed the radiological findings of PBI (symptomatic pancreatitis, cholecystitis, or cholangitis). The PBI effect on treatment was statistically evaluated. PBI (pancreatitis, n = 1; cholecystitis, n = 7; and cholangitis, n = 2) was diagnosed in 11.5% (9/78) of the patients at a median of 35 days after treatment initiation; 6 of 9 patients discontinued treatment because of PBI. Three cases of cholecystitis and 1 of cholangitis were accompanied by gallstones, while the other 5 were acalculous. The treatment duration was significantly shorter in patients with PBI than in those without (median: 44 days vs. 201 days, P = .02). Overall, 9 of 69 patients without PBI showed asymptomatic gallbladder subserosal edema. Lenvatinib-induced PBI developed in 11.5% of patients, leading to a significantly shorter treatment duration. Approximately 55.6% of the PBI cases were acalculous. The recognition of this phenomenon would aid physicians during treatment planning in the future.

The Development of Lenvatinib-Induced Pancreatitis in a Patient with Metastatic Neuroendocrine Tumor: A Case Report

“…The patient with pancreatitis was being treated with lenvatinib for hepatocellular carcinoma and had been taking the medication for 11 weeks prior to having abdominal pain. The patient had a similar timeframe of symptoms compared to our patient, however did have imaging findings consistent with acalculous cholecystitis in addition to fat stranding surrounding the pancreas [12]. This may suggest that patients with lenvatinibinduced pancreatitis may be susceptible to other complications such as cholecystitis; however, more information would be needed to make this conclusion.…”

Drug-induced bile duct injury: new agents, new mechanisms

“…The toxicity is mainly hepatocellular and the incidence of bile duct injury is difficult to ascertain as liver biopsy is far from having been always performed. However, some documented cases of small-duct cholangiopathy and sclerosing cholangitis have been reported, for instance, with imatinib [10], lapatinib [27], or lenvatinib [28 ▪ ].…”

Cholecystitis and cholangitis associated with lenvatinib: A pharmacovigilance study

“…[2][3][4] In Japan, the Pharmaceuticals and Medical Devices Safety Information has added cholecystitis as the clinically significant adverse reaction.Recently, cholangitis was also reported during lenvatinib treatment. 5 Due to lack of evidence for lenvatinib-related cholangitis, we performed a pharmacovigilance analysis using the FDA Adverse Event Reporting System (FAERS) database to further assess the association between lenvatinib and cholangitis and compare the clinical characteristics of lenvatinib-related cholecystitis and cholangitis.…”