Acute pancreatitis associated with molecular targeted therapies: a retrospective review of the clinico-radiological features, management and outcome.
OBJECTIVE
To study the presentation, radiological features, management and outcome of acute pancreatitis detected on imaging in patients receiving molecular targeted therapy (MTT).


METHODS
In this IRB-approved, HIPAA-compliant retrospective study, search of the radiology database from January 2005 through September 2012 revealed 91 cancer patients with radiologic evidence of acute pancreatitis. Of these, 15 patients receiving MTT (7 women, 8 men; mean age 59 years, range 25-84 years) and fulfilling the criteria of acute pancreatitis without any confounding factors were included. Imaging at initial diagnosis of pancreatitis and subsequently were reviewed by three radiologists in consensus; clinical presentation, management, and outcome were documented from the medical record.


RESULTS
Eleven patients had focal and four had diffuse pancreatitis. The tail of the pancreas (n = 6) was the most common site of focal pancreatitis. Of the 14/15 patients who underwent CT, modified CT severity index was 2 in 12 patients and 4 in 2 patients. One patient (1/15) who underwent only FDG-PET/CT showed focal pancreatitis. None of the patients had pancreatic necrosis or peripancreatic collections. Findings resolved in all the patients after discontinuation of MTT, except in one patient who died of progressive disease. No radiological or surgical interventions were required in any of the patients. Findings recurred in 4/9 patients (44%) in whom MTT was restarted.


CONCLUSIONS
MTT-associated pancreatitis is usually mild, focal, and managed conservatively with discontinuation of MTT. The imaging findings are subtle and in our study, pancreatitis recurred in 44% of patients after restarting MTT.
Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: stirumani@partners.org.
Sree Harsha
SH
Tirumani
Jyothi P
JP
Jagannathan
Atul B
AB
Shinagare
Kyung won
Kw
Kim
Katherine M
KM
Krajewski
Nikhil H
NH
Ramaiya
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D010195:Pancreatitis / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
Acute pancreatitis; Cancer; MDCT; Molecular targeted therapy