Albendazole in malignant ascites: a case report and literature review on the successes and adverse effects of therapy

Abstract

Malignant ascites places a significant burden on the healthcare system and has a profound effect on patient quality of life. Albendazole (ABZ) is an anti-helminthic agent that has shown to rapidly reduce malignant ascites with minimal side effects in pre-clinical trials. The following case study explores the effect of ABZ on ascitic volume in a patient with malignant ascites secondary to metastatic colorectal adenocarcinoma. The patient is a 54-year-old man who underwent an ultrasound guided ascitic drainage for worsening ascites secondary to hepatic metastases from sigmoid adenocarcinoma. He was commenced on ABZ based on literature demonstrating that ABZ decreases the volume of malignant ascites via the inhibition of vascular endothelial growth factor. Over the next week, the volume of ascitic fluid decreased significantly, however the patient developed neutropenia unresponsive to granulocyte colony stimulating factor likely in the context of impaired liver function. The efficacy of ABZ in this case study as well as in the literature demonstrates the promising potential for use in reducing malignant ascites. However, this case demonstrates the need for caution for use in patients with liver impairment due to changes to first pass metabolism leading to increased circulating drug toxicity and thus, adverse outcomes.