Abstract
The incidence of pancreatic cancer is increasing. Most patients have advanced disease at diagnosis, and therapeutics is limited in this setting. Gemcitabine and nab-paclitaxel combination is indicated as first-line treatment in patients with metastatic cancer of pancreas. The most common adverse events of Grade 3 or higher gemcitabine and nab-paclitaxel combination are neutropenia, fatigue and neuropathy. In this report, we describe a rare case of organizing pneumonia associated with the use of nab-paclitaxel and gemcitabine in metastatic pancreatic cancer. A 68-year-old female underwent total splenopancreatectomy for ductal adenocarcinoma of the neck of the pancreas, followed by adjuvant chemoradiation therapy. Afterwards she relapsed and received first-line chemotherapy with gemcitabine plus nab-paclitaxel combination for 12 cycles. Following the administration of the 12th cycle of gemcitabine plus nab-paclitaxel, the patient experienced low-grade pyrexia, effort dyspnoea, persistent non-productive cough and malaise. High-resolution CT scan of chest revealed new-onset bilateral peripheral ground-glass opacities, smooth interlobular septal thickening and patchy subpleural consolidation areas, findings consistent with organizing pneumonia. A thorough microbiological workup was negative. Treatment with steroids resulted in prompt clinical and radiological improvement. Organizing pneumonia closely mimics infection or progressive disease and can be difficult to diagnose in the setting of malignancy. Correct diagnosis is of primary importance since delay in treatment can result in significantly adverse patient outcomes.
Highlights
Pancreatic cancer is one of the most challenging human malignancies and ranks as the fourth leading cause of cancer-related mortality in the United States and Europe,[1] with a 5-year survival rate of 7 to 8% among all disease stages.[2,3,4] Surgery offers the only curative treatment for pancreatic cancer; in the large majority of cases, diagnosis is made at an advanced stage, when patients already have metastases or locoregional extension precluding curative surgical resection.[5]
During the past 5 years, two Phase III studies demonstrated that the FOLFIRINOX regimen and the gemcitabine plus nab-paclitaxel regimen significantly improve survival in patients with metastatic adenocarcinoma of the pancreas.[6,7]
organizing pneumonia (OP) or bronchiolitis obliterans OP is a known manifestation of drug-induced lung injury
Summary
Pancreatic cancer is one of the most challenging human malignancies and ranks as the fourth leading cause of cancer-related mortality in the United States and Europe,[1] with a 5-year survival rate of 7 to 8% among all disease stages.[2,3,4] Surgery offers the only curative treatment for pancreatic cancer; in the large majority of cases, diagnosis is made at an advanced stage, when patients already have metastases or locoregional extension precluding curative surgical resection.[5]. Following the administration of cycle 12, day 15 of gemcitabine plus nab-paclitaxel, the patient experienced low-grade pyrexia, effort dyspnoea, persistent non-productive cough and malaise. She was empirically treated with a 5-day course of levofloxacin as outpatient, without any beneficial effects, and for the worsening of the symptoms she was eventually hospitalized. High-resolution computed tomography (HRCT) scan showed new-onset bilateral peripheral ground-glass opacities, smooth interlobular septal thickening and patchy subpleural consolidation areas. These findings were consistent with OP (Figure 1). HRCT scan performed after 2 months showed disappearance of alveolar infiltrates and complete resolution of consolidation (Figure 2)
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