Biliary and pancreatic complications of molecular targeted therapies in cancer imaging.
The purpose of this review is to familiarize radiologists with the different imaging manifestations of biliary and pancreatic toxicity of molecular targeted therapies. The advent of molecular targeted therapies for cancer treatment has prompted radiologists to be familiar with these new molecules, their patterns of response, and their class-specific toxicities. While liver and bowel toxicities have been extensively reported in literature, less is known about the pathogenesis and imaging of toxicity involving the pancreatobiliary system. Biliary and pancreatic toxicity of molecular targeted therapies present with variable manifestations and varying degrees of severity, from asymptomatic liver function tests elevation to acute pancreatitis or cholecystitis. Management of these conditions depends on the clinical scenario and the severity of the findings. In this article, we will (1) present the various classes of molecular targeted therapies most commonly associated with biliary and pancreatic toxicity; (2) illustrate imaging findings of drug-associated biliary and pancreatic injuries and their possible differential diagnosis; and (3) provide a guide for management of these conditions.
Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. Francesco_Alessandrino@dfci.harvard.edu.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. Francesco_Alessandrino@dfci.harvard.edu.
Francesco
0000-0002-1681-1284
F
Alessandrino
Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Katherine M
KM
Krajewski
Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Sree Harsha
SH
Tirumani
Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Marta
M
Braschi-Amirfarzan
Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Jyothi P
JP
Jagannathan
Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Nikhil H
NH
Ramaiya
Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.|Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Donald N
DN
Di Salvo
D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*
Abdominal toxicities; Acute pancreatitis; Cholecystitis; Cholestasis; Molecular targeted therapies; Pancreatic atrophy