Sorafenib-Induced Acute Pancreatitis in a Patient with Differentiated Thyroid Cancer

Abstract

Background: Sorafenib is a tyrosine kinase inhibitor approved for the treatment of metastatic renal cell carcinoma, hepatocellular carcinoma, and recently for radioactive iodine (RAI)-refractory metastatic differentiated thyroid carcinoma (DTC). Several side effects have been described including alterations in amylase and lipase levels. Nonetheless, only a few cases of pancreatitis during renal carcinoma and hepatocellular carcinoma treatment have been described. Objective: To describe the first case report of sorafenib-induced acute pancreatitis during the treatment of thyroid carcinoma. Methods and Results: In a 60-year-old Latin woman with RAI-refractory papillary thyroid carcinoma, T4bN1bM1, sorafenib was indicated due to locally recurrent, metastatic, and progressive lung involvement without iodine uptake. Therapy was initiated (200 mg) every 8 h. Three days after starting the medication, abdominal pain, nausea, and emesis appeared. A blood test revealed elevated amylase (343 U/L RV: 28–100) and lipase (1,969 U/L RV: 23–300) levels, but no other findings, confirming acute mild pancreatitis. Hypertriglyceridemia, hypercalcemia, and alcohol and biliary etiologies were ruled out and sorafenib-acute pancreatitis was concluded. Two weeks later, sorafenib was resumed without recurrence. To date, this is the tenth sorafenib-related pancreatitis report and the first in a patient with RAI-refractory metastatic DTC. Conclusions: Sorafenib-acute pancreatitis may develop in patients with RAI-refractory thyroid cancer. This adverse event seems to be inde­pendent of the treatment duration and administered dose. Resuming the medication with an adjusted dose after pancreatitis resolution may be safe.

Bevacizumab and Pancreatitis; an Uncommon Association

“…Its inhibition may cause pancreatic ischemia, apoptosis of acinar cells, and release of autodigestive enzymes resulting in pancreatitis. 4 Our report highlights a rare adverse effect of bevacizumab use and the importance of a thorough medication list review in patients with acute pancreatitis with no identifiable cause.…”

Multidisciplinary consensus recommendations for management of hepatocellular carcinoma in Middle East and North Africa region

“…Treatment‐related adverse events (TRAEs) are commonly seen with TKIs that range from hand‐foot‐skin reaction, fatigue and increased blood pressure to more severe pancreatitis, increased risk of haemorrhage and pancytopenia. Increased TRAEs as reported by clinical trials (Resorce Trial on Regorafenib: 67%, Celestial Trial on Cabozantinib: 68%, Reflect Trial on Lenvatinib: 75%) have led to treatment interruptions and dose reductions 111–115 …”

“…Increased TRAEs as reported by clinical trials (Resorce Trial on Regorafenib: 67%, Celestial Trial on Cabozantinib: 68%, Reflect Trial on Lenvatinib: 75%) have led to treatment interruptions and dose reductions. [111][112][113][114][115] Lenvatinib is an alternative to Sorafenib and has been approved as the first-line treatment for patients with advanced HCC with a higher radiological response rate and better PFS, but comparable overall survival (OS) to Sorafenib. Regorafenib, that targets angiogenesis, tumour cell as well as the fibroblast growth factor (FGF) receptor more intensely than sorafenib, can be used post-progression on sorafenib and is approved as the second-line treatment option for patients with advanced HCC.…”