Lenvatinib是一种酪氨酸激酶抑制剂,基于TALENT试验的成功,被用于治疗神经内分泌肿瘤。在接受甲状腺癌治疗的患者中,有两例记录了lenvatinib诱发的胰腺炎。该报告描述了在接受lenvatinib治疗的转移性神经内分泌肿瘤患者中发现的第一例胰腺炎。一名68岁女性主诉上腹部腹痛,恶心,和呕吐。她在出现前3个月开始接受lenvatinib治疗,并在症状恶化前1周停用药物。这个病人表现为上腹痛向背部放射,CT影像学表现与急性胰腺炎一致,但只有88的脂肪酶。一旦诊断出胰腺炎,用静脉输液开始治疗,保持所有口服摄入和疼痛管理。患者在住院5天后耐受口服后出院。结论是,胰腺炎可能是由lenvatinib引起的,作为急性胰腺炎的其他病因,包括胆结石,酒精使用,高甘油三酯血症,高钙血症被排除。使用lenvatinib治疗神经内分泌肿瘤的临床医生应了解胰腺炎的发生,并可考虑定期监测胰腺炎的体征和症状。关于lenvatinib诱导的胰腺炎的机制和发展的更多研究可能有利于考虑lenvatinib治疗的患者的临床决策。此外,对于有胰腺炎病史的患者,可能需要密切监测该疗法.
Lenvatinib is a tyrosine kinase inhibitor that is being used to treat neuroendocrine tumors based on the success shown in the TALENT trial. There are two documented cases of lenvatinib-induced pancreatitis in patients being treated for thyroid cancer. This report describes the first
case of pancreatitis seen in a patient with a metastatic neuroendocrine tumor being treated with lenvatinib. A 68-year-old female presented with a chief complaint of epigastric abdominal pain, nausea, and vomiting. She started on lenvatinib therapy 3 months prior to presentation and discontinued the drug 1 week prior due to worsening symptoms. This patient presented with epigastric pain radiating to the back, CT imaging findings consistent with acute pancreatitis, but only a lipase of 88. Once the diagnosis of pancreatitis was made, treatment was initiated with IV fluids, holding all oral intake and pain management. The patient was discharged after she tolerated oral intake after 5 days of hospitalization. It was concluded that the pancreatitis was likely caused by lenvatinib as other etiologies of acute pancreatitis including gallstones, alcohol use, hypertriglyceridemia, and hypercalcemia were ruled out. Clinicians who are using lenvatinib to treat neuroendocrine tumors should be aware of the occurrence of pancreatitis and may consider periodic monitoring for signs and symptoms of pancreatitis. More research regarding the mechanism and development of lenvatinib-induced pancreatitis may benefit clinical decision-making in patients being considered for lenvatinib therapy. Additionally, this therapy may need to be monitored closely in patients with a history of pancreatitis.