title: A case report of gemcitabine treatment for duodenal cancer: the good (a sustained response) and the bad (life threatening refractory thrombotic thrombocytopenic purpura).
abstract: BACKGROUND
  Adenocarcinoma of the duodenum is a rare cancer and not submitted to the type of clinical trials that guide chemotherapy treatments in other gastrointestinal malignancies.
  
  
  METHODS
  This case demonstrates the potential use for gemcitabine, a chemotherapy typically used in pancreas and biliary tract tumors, in this difficult to treat disease as this patient had a partial response to single agent gemcitabine. Unfortunately, this case also demonstrates one of the rare potential adverse reactions to gemcitabine, which is the development of thrombotic thrombocytopenic purpura (TTP).
  
  
  CONCLUSIONS
  In this case, the TTP was extremely difficult to treat but was resolved with splenectomy.
authors.affiliation: Regional Cancer Program of Sudbury Regional Hospital, Northern Ontario School of Medicine, 41 Ramsey Lake R, Sudbury, ON P3E 5J1, Canada. arobinson@hrsrh.on.ca
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004379:Duodenal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009852:Omentum / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine