A Case of Recurrent Acute Pancreatitis After Gemcitabine + Nab-Paclitaxel and Modified FOLFIRINOX Therapy for Advanced Recurrent Pancreatic Cancer

The incidence of drug-induced acute pancreatitis is an important consideration when developing treatment strategies for patients with pancreatic ductal adenocarcinoma. We report a case of recurrent acute pancreatitis that developed following both gemcitabine plus nab-paclitaxel (GnP) chemotherapy and modified FOLFIRINOX (mFFX) therapy. The clinical stage at initial diagnosis was cT3N1M0 stage IIB pancreatic cancer, with subsequent progression to metastatic disease over approximately 1.5 years. Treatment was prioritized at each stage of disease progression despite the occurrence of acute pancreatitis. Recurrent episodes of acute pancreatitis prompted a change in chemotherapy regimen from GnP to mFFX; however, a single causative agent could not be identified. For both chemotherapy regimens, the onset of acute pancreatitis occurred within 24 hours of treatment initiation, and the clinical course was mild, consistent with previous reports of drug-induced pancreatitis. Agents common to both regimens, specifically 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, may have contributed to the development of pancreatitis. Further accumulation of similar cases is required to better clarify the relationship between pancreatic cancer chemotherapy and the risk of acute pancreatitis.