SAT-258 Paclitaxel-Associated Very Severe Hypertriglyceridemia in a Patient with Breast Cancer and Type 2 Diabetes: A Diagnostic and Therapeutic Challenge

Abstract Disclosure: H. Mon: None. S. Qureshi: None. Background: Paclitaxel, a widely-used chemotherapeutic agent, is rarely associated with hypertriglyceridemia. Very severe hypertriglyceridemia(>50 mmol/L) can lead to life-threatening complications, such as acute pancreatitis, especially in patients with predisposing factors including diabetes. Case Presentation: We report a 63-year-old lady with type 2 diabetes mellitus managed with insulin, gliclazide, and metformin, who was diagnosed with right-sided breast cancer. Following surgery, she was started on weekly paclitaxel in July 2024, with a plan to follow by doxorubicin and cyclophosphamide on completion of 4 cycles of Paclitaxel. Her triglyceride level was 6.5 mmol/L(reference range <1.7 mmol/L) before initiating chemotherapy. In September 2024, she presented to Diabetes clinic with worsening glycemic control despite increased insulin requirements. Interestingly, further laboratory investigations at Diabetes clinic revealed very severe hypertriglyceridemia(>50 mmol/L). Initial staging CT(chest, abdomen and pelvis) showed no pancreatic abnormalities, but repeat scans demonstrated an atrophic pancreas. Management: Conventional therapy with intravenous insulin, high-dose atorvastatin, ezetimibe, and fibrates did not achieve the control her triglyceride levels. Consequently, alirocumab,a PCSK9 inhibitor, was initiated at 75 mg and uptitrated to 150 mg biweekly. This resulted in significant reduction in triglyceride levels to <10 mmol/L. Conclusion: We report a rare case of Paclitaxel-associated very severe hypertriglyceridemia in a patient with breast cancer and pre-existing type 2 diabetes, highlighting its unique diagnostic and therapeutic challenges. This case underscores the critical importance of monitoring lipid profiles in patients undergoing paclitaxel therapy, particularly those with diabetes, as they may be at an increased risk of severe metabolic complications. Precise mechanism underlying paclitaxel-induced hypertriglyceridemia remains unclear and warrants further investigation. Additionally, it demonstrates the potential role of PCSK9 inhibitors as an effective therapeutic option in managing refractory hypertriglyceridemia. Further research is essential to elucidate the pathophysiology of paclitaxel-induced lipid abnormalities and to develop optimized treatment strategies for affected patients. Presentation: Saturday, July 12, 2025