Pazopanib-induced asymptomatic radiological acute pancreatitis: A case report

Abstract

The universal clinical use of multi-targeted tyrosine kinase inhibitors (TKIs) in patients diagnosed with advanced renal cell carcinoma (RCC) has significantly prolonged their estimated survival times and their quality of life. However, several adverse side-effects associated predominantly with the inhibition of the vascular endothelial growth factor receptor by these drugs may prove to be potentially life-threatening. One adverse event that is only rarely observed with the use of TKIs in this clinical setting is acute pancreatitis. In the present study, to the best of our knowledge, the first case of asymptomatic radiological acute pancreatitis associated with the use of pazopanib in monotherapy in a patient with RCC is presented. In addition, a comprehensive review of the literature on this topic is provided, and certain potential measures that may aid in early diagnosis and treatment are discussed.

Keywords: acute pancreatitis; pazopanib; renal cell carcinoma; toxicity; tyrosine kinase inhibitors.

Figure 1.

Serial contrast-enhanced CT imaging of a 67-year-old male patient with pazopanib-induced asymptomatic radiological acute pancreatitis. (A) At baseline, no alterations of the pancreas were identified. (B) At 2 months following the initiation of treatment with pazopanib, CT imaging revealed focal acute edematous pancreatic tail and body pancreatitis. (C) A worsening of the pancreatitis is shown in the posterior revaluation, and therefore treatment with pazopanib was maintained. After initiating treatment with sorafenib, (D) stabilization of acute pancreatitis was observed, which was maintained (E and F) on further examinations

Figure 2.

The changes noted in the serum amylase levels. Asymptomatic acute pancreatitis was diagnosed 2 months after initiation of the treatment, with increasing levels of serum amylase noted until pazopanib discontinuation. Decreasing levels and normalization of serum amylase levels were observed after holding pazopanib, and under sorafenib treatment.