1299 Sorafenib Induce Acute Pancreatitis: A Seldom Reported Side Effect

Abstract

INTRODUCTION: Sorafenib is a multikinase inhibitor that has been used successfully in patients with hepatocellular carcinoma. Given its recent approval in the market, many of its side effects are still being uncovered. Here we present a rare case of Sorafenib induced acute pancreatitis. CASE DESCRIPTION/METHODS: The patient is a 60-year-old male with a medical history of hepatocellular carcinoma (stage IV with metastasis to bone), Hepatitis C virus, hypertension and rheumatoid arthritis who presented to the emergency department complaining of slowly progressive epigastric abdominal pain for 2 weeks. Of note the patient was started on Sorafenib 400 mg twice daily three weeks prior as an outpatient. Notable laboratory workup included a lipase of 189 U/L and a triglyceride level of 70 mg/dL. Notable imaging included a computed tomography of the abdomen which showed mild peri-pancreatic haziness consistent with acute pancreatitis and a ill defined hypodense lesion in the right hepatic lobe that was unchaged from previous imaging. The patient was then admitted under the impression of acute pancreatitis secondary to Sorafenib. Prior to reaching this diagnosis, alternate etiologies of acute pancreatitis were ruled out. This included ingestion of alcohol, hypertrigliceridemia, cholelithiasis and other medications. During his admission the patients diet was held and he was given early intravenous fluid resuscitation. Two days later his abdominal pain resolved and he was safely discharged home with follow up appointments. On follow up visit the patient was restarted on Soraenib at a lower dose (200 mg twice daily) with no recurrence of symptoms. DISCUSSION: Sorafenib induced pancreatitis is a rare complication that has seldom been reported in the literature and whose pathogenesis has not been completely elucidated. One theory suggests that it results from pancreatic ischemia that occurs secondary to sorafenib's anti-androgenic effect on vascular endothelial growth factor (VEGRF). A second theory suggests that sorafenib's effect on gastrointestinal dysmotility results in reflux of duodenal contents into the pancreatic duct. Diagnosis of sorafenib induced pancreatitis can be done after ruling out secondary causes of pancreatitis (ie: alcohol, hypertriglyceridemia). Treatment of sorafenib induced pancreatitis includes cessation of the offending agent. There have been reported cases where sorafenib was resumed at a lower dose after initial cessation, with no clinical sequelae as was the case with our patient.