Possible drug-associated pancreatitis after paclitaxel-cremophor administration.
Paclitaxel, a relatively new antineoplastic agent, is associated with numerous side effects, including two reported cases of pancreatitis. Our patient also developed paclitaxel-associated pancreatitis. Several companion drugs, including steroids, diphenhydramine, histamine2 blockers, serotonin type 3 antagonists, and other chemotherapeutic agents administered with paclitaxel, must be considered as possible causes of pancreatitis. In addition, paclitaxel is a hydrophobic agent that requires a vehicle, cremophor (CrEL), for solubility. Intravenous cyclosporine also requires CrEL and has been associated with pancreatitis. In the cerulein-induced pancreatitis rat model, paclitaxel with dimethyl sulfoxide as a vehicle prevents pancreatitis, suggesting that another causal agent is responsible. Animal studies of CrEL as a single agent may be required to settle this question, but for now, awareness that paclitaxel may be associated with pancreatitis may lead to earlier treatment of this potentially fatal complication.
Mills
K M
KM
Department of Internal Medicine, LSU Health Sciences Center, Shreveport, Louisiana 71130, USA.
Johnson
D M
DM
Middlebrooks
M
M
Burton
G V
GV
D000208:Acute Disease; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects*; D010195:Pancreatitis / Q000139:chemically induced* / Q000175:diagnosis; D014677:Pharmaceutical Vehicles / Q000008:administration & dosage / Q000009:adverse effects*; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*
D000972:Antineoplastic Agents, Phytogenic; D014677:Pharmaceutical Vehicles; C022131:cremophor; D011092:Polyethylene Glycols; D017239:Paclitaxel