PEGylated Liposomal Doxorubicin Rechallenge following Doxorubicin-induced Pancreatitis

Abstract

Drug induced pancreatitis is rare and establishing the exact causal relationship is challenging. Here, we discuss the management of a 60 year-old female patient with stage 3a breast cancer who developed doxorubicin induced pancreatitis 3 days after her first treatment with cyclophosphamide and doxorubicin chemotherapy. This patient had locally advanced cancer and there remained a significant risk of metastatic disease in the absence of chemotherapy. Therefore, she opted for rechallenge despite the risk of recurrent pancreatitis. She commenced cyclophosphamide and PEGylated-liposomal doxorubicin at 30mg/m2, instead of conventional doxorubicin and tolerated this well, without recurrence of pancreatitis. Doxorubicin is becoming increasingly associated with pancreatitis, with high incidence of recurrence upon rechallenge. PEGylated liposomal doxorubicin has not been shown to cause pancreatitis and there is evidence supporting its use for treating breast cancer. A potential strategy for continued treatment following doxorubicin-induced pancreatitis, may be to substitute conventional doxorubicin with PEGylated liposomal doxorubicin.

Keywords

• Pancreatitis
• Breast Cancer
• Doxorubicin
• Rechallenge