title: Severe hyponatremia caused by nab-paclitaxel-induced syndrome of inappropriate antidiuretic hormone secretion: A case report in a patient with metastatic pancreatic adenocarcinoma.
abstract: Incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing. Most patients have advanced disease at diagnosis and therapeutic options in this setting are limited. Gemcitabine plus nab-paclitaxel regimen was demonstrated to increase survival compared with gemcitabine monotherapy and is therefore indicated as first-line therapy in patients with metastatic PDAC and performance status Eastern Cooperative Oncology Group (ECOG) 0-2. The safety profile of gemcitabine and nab-paclitaxel combination includes neutropenia, fatigue, and neuropathy as most common adverse events of grade 3 or higher. No case of severe hyponatremia associated with the use of nab-paclitaxel for the treatment of PDAC has been reported to date.We report the case of a 72-year-old Caucasian man with a metastatic PDAC treated with gemcitabine and nab-paclitaxel regimen, who presented with a severe hyponatremia (grade 4) caused by a documented syndrome of inappropriate antidiuretic hormone secretion (SIADH). This SIADH was attributed to nab-paclitaxel after a rigorous imputability analysis, including a rechallenge procedure with dose reduction. After dose and schedule adjustment, nab-paclitaxel was pursued without recurrence of severe hyponatremia and with maintained efficacy.Hyponatremia is a rare but potentially severe complication of nab-paclitaxel therapy that medical oncologists and gastroenterologists should be aware of. Nab-paclitaxel-induced hyponatremia is manageable upon dose and schedule adaptation, and should not contraindicate careful nab-paclitaxel reintroduction. This is of particular interest for a disease in which the therapeutic options are limited.
authors.affiliation: aDepartment of Medical Oncology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est Créteil University (UPEC) bDepartment of Pharmacovigilance, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est Créteil University (UPEC) cDepartment of Pharmacology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est Créteil University (UPEC), Créteil, France.
authors.forename: Cindy
authors.initials: C
authors.lastname: Neuzillet
authors.forename: Samy
authors.initials: S
authors.lastname: Babai
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Kempf
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pujol
authors.forename: Benoît
authors.initials: B
authors.lastname: Rousseau
authors.forename: Hervé
authors.initials: H
authors.lastname: Le-Louët
authors.lastname: Christophe Tournigand
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary*; D000368:Aged; D000418:Albumins / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D007177:Inappropriate ADH Syndrome / Q000150:complications* / Q000209:etiology*; D008297:Male; D017239:Paclitaxel / Q000009:adverse effects* / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology*; D012720:Severity of Illness Index
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D017239:Paclitaxel