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Fabien MB, Elodie P, Anna S, Addeo P, Meher B. Gemcitabine-induced peripheral vascular disease and prolonged response in a patient with metastatic pancreatic adenocarcinoma: A case report. World J Clin Cases 2023; 11:1372-1378. [PMID: 36926125 PMCID: PMC10013109 DOI: 10.12998/wjcc.v11.i6.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Gemcitabine is an antimetabolite used in the treatment of pancreatic cancer. One of the side effects of gemcitabine is vascular toxicity. Here, we report the case of a patient treated with gemcitabine who had peripheral vascular disease concomitant with a prolonged antitumor response.
CASE SUMMARY A 75-year-old man was diagnosed with locally recurrent pancreatic cancer. Partial response was achieved after 9 mo of gemcitabine. At the same time, the patient reported peripheral vascular disease without necrosis. Chemotherapy was suspended, and after one month the Positron Emission Tomography (PET) scan showed locoregional tumor recurrence. Gemcitabine was resumed and partial response was obtained, but peripheral vascular disease occurred.
CONCLUSION Our results suggest that the appearance of peripheral vascular disease may be related to a prolonged response to gemcitabine.
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Affiliation(s)
- Moinard-Butot Fabien
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg 67200, France
| | - Poprawa Elodie
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg 67200, France
| | - Schohn Anna
- Department of Supportive Care, Institut de cancérologie Strasbourg Europe, Strasbourg 67200, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg 67200, France
| | - Benabdelghani Meher
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg 67200, France
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Khan AM, Arjyal L, Shamaileh L, Simon M. Gemcitabine-induced digital ischaemia in a patient with metastatic breast cancer. BMJ Case Rep 2022; 15:e252083. [PMID: 36319039 PMCID: PMC9628528 DOI: 10.1136/bcr-2022-252083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A woman in her 50s with HER2 (human epidermal growth factor receptor 2) positive, estrogen/progesterone receptor negative, metastatic invasive ductal carcinoma of the breast, presented with acral cyanosis and severe throbbing pain after recent administration of gemcitabine. She was treated with aspirin, heparin, amlodipine, topical nitroglycerin and analgesics. Gemcitabine was discontinued permanently. She had a gradual recovery except for a small necrotic area over the right 4th digit. However, surgical intervention was avoided.
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Affiliation(s)
- Abdul Moiz Khan
- Hematology and Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Lubina Arjyal
- Hematology and Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Lelas Shamaileh
- Hematology and Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michael Simon
- Hematology and Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
- Oncology, Wayne State University, Detroit, Michigan, USA
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3
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Geier M, Babey H, Monceau-Baroux L, Quéré G, Descourt R, Cornec D, Robinet G. Vascular Acrosyndromes Associated With Prolonged Tumor Response in Advanced Lung Cancer Patients During Treatment With Antimetabolites: A Report of Two Cases. Front Oncol 2021; 11:644282. [PMID: 33869037 PMCID: PMC8047622 DOI: 10.3389/fonc.2021.644282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Pemetrexed and gemcitabine are both antimetabolites drugs approved in advanced non-small cell lung cancer (NSCLC). Their toxicity profile is well known. However, rare vascular side effects can occur such as vascular acrosyndromes and especially digital ischemia. The cause of this disfiguring and painful event is still controversial. Amputation is frequently required and has been described as a predictor of poor survival outcomes. Case Presentation This report presents two cases of vascular acrosyndrome in NSCLC patients during treatment with antimetabolites (pemetrexed and gemcitabine). Patients presented severe digital ischemia having required prostacyclin analog and chemotherapy discontinuation. In one case, symptoms improved while in the other case symptoms persisted. Both patients experienced prolonged tumor response. These findings suggest a multifactorial mechanism behind digital necrosis including an autoimmune process, which could lead to prolonged tumor control as described with immune checkpoint inhibitors. Conclusion Severe vascular acrosyndrome such as digital ischemia can occur in lung cancer patients treated with antimetabolites. Awareness needs to be raised when using these drugs in patients with predisposing factors. Whether occurrence of chemotherapy-induced immune vascular side effects might explain prolonged tumor response deserves further investigations.
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Affiliation(s)
- Margaux Geier
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
| | - Hélène Babey
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
| | - Lucie Monceau-Baroux
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
| | - Gilles Quéré
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
| | - Renaud Descourt
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
| | - Divi Cornec
- Department of Rheumatology, CHRU Cavale Blanche, University Hospital of Brest, Brest, France
| | - Gilles Robinet
- Department of Oncology, Centre Hospitalier Regional Universitaire (CHRU) Morvan, University Hospital of Brest, Brest, France
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Pauling JD. The challenge of establishing treatment efficacy for cutaneous vascular manifestations of systemic sclerosis. Expert Rev Clin Immunol 2018; 14:431-442. [PMID: 29641934 DOI: 10.1080/1744666x.2018.1464390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The cutaneous vascular manifestations of systemic sclerosis (SSc) comprise Raynaud's phenomenon, cutaneous ulceration, telangiectasia formation and critical digital ischaemia; each of which are associated with significant disease-related morbidity. Despite the availability of multiple classes of vasodilator therapy, many of which have been the subject of RCTs, a limited number of pharmacological interventions are currently approved for the management of cutaneous vascular manifestations of SSc. Areas covered: A major challenge has been demonstrating treatment efficacy with examples of promising therapies yielding contrasting results in controlled trial settings. Differences between consensus best-practice guidelines, evidence-based recommendations and marketing approvals in different jurisdictions has resulted in geographic variation in clinical practice concerning the management of cutaneous vascular manifestations of SSc. Difficulty demonstrating treatment efficacy risks waning industry engagement for drug development programmes in this field. This article highlights the key challenges in establishing treatment efficacy and barriers that must be overcome to support successful clinical trial programmes across the spectrum of cutaneous vascular manifestations of SSc. Expert commentary: The paucity of approved treatments for cutaneous vascular manifestations of SSc relates as much to challenges in clinical trial design and the need for reliable clinical trial endpoints, as to lack of therapeutic options.
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Affiliation(s)
- John D Pauling
- a Department of Rheumatology, Royal National Hospital for Rheumatic Diseases , Royal United Hospitals NHS Foundation Trust , Bath , UK.,b Department of Pharmacy and Pharmacology , University of Bath , Bath , UK
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So E, Crees ZD, Crites D, Wang-Gillam A. Digital Ischemia and Necrosis: A Rarely Described Complication of Gemcitabine in Pancreatic Adenocarcinoma. J Pancreat Cancer 2017. [DOI: 10.1089/crpc.2017.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eiichiro So
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Zachary D. Crees
- Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Danielle Crites
- Division of Hematology and Oncology, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Andrea Wang-Gillam
- Division of Hematology and Oncology, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
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So E, Crees ZD, Crites D, Wang-Gillam A. Digital Ischemia and Necrosis: A Rarely Described Complication of Gemcitabine in Pancreatic Adenocarcinoma. J Pancreat Cancer 2017; 3:49-52. [PMID: 30631842 PMCID: PMC5933482 DOI: 10.1089/pancan.2017.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Gemcitabine, alone or in combination with other agents, has become an important part of the standard of care for treatment of both resectable and unresectable/advanced pancreatic adenocarcinoma. Gemcitabine is generally considered to have a favorable toxicity profile, with myelosuppression and hepatotoxicity as the most common adverse effects. There are just two prior published case reports of gemcitabine-associated digital toxicity in the treatment of pancreatic adenocarcinoma, and few case reports when considering all solid tumors. Presentation: A 70-year-old female developed hand numbness and tingling while receiving nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma. There was initial concern for Raynaud's or nab-paclitaxel-associated neuropathy, thus nab-paclitaxel was discontinued. However, her symptoms progressed to severe pain and her digits became dusky. An extensive evaluation revealed no alternative etiology except gemcitabine-associated digital ischemia (DI). The patient was treated with discontinuation of gemcitabine, and starting nitrates, opiates, calcium-channel blockers, and enoxaparin but eventually progressed to dry gangrene. Conclusion: Here we report a case of gemcitabine-associated DI, along with a review of the literature. Although a rare complication, DI must be recognized and treated promptly to reduce the likelihood of serious and permanent morbidity.
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Affiliation(s)
- Eiichiro So
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Zachary D Crees
- Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Danielle Crites
- Division of Hematology and Oncology, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Andrea Wang-Gillam
- Division of Hematology and Oncology, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
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Bouquet É, Urbanski G, Lavigne C, Lainé-Cessac P. Unexpected drug-induced Raynaud phenomenon: Analysis from the French national pharmacovigilance database. Therapie 2017; 72:547-554. [PMID: 28336160 DOI: 10.1016/j.therap.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the association between exposure to medicinal products and Raynaud phenomenon. METHODS The study used the data of all adverse drug reactions notified to the French national pharmacovigilance database. All cases reported between 1st January 1995 and 10th December 2012 were selected. A case/non-case method was used to measure disproportionality of the association between drug exposure and Raynaud phenomenon. The cases concerned all observations involving Raynaud phenomenon. Non-cases comprised all other reports of adverse drug reactions over the same period. RESULTS/DISCUSSION Among the 307,128 adverse drug reaction reports selected from the French national pharmacovigilance database, 175 involved Raynaud phenomenon, most of them affecting women (61.1%). The mean age was 50.1 years, and 8% had a past medical history of Raynaud phenomenon. According to the summaries of product characteristics, 42.3% of these cases were exposed to drugs known to induce Raynaud phenomenon. Unexpected Raynaud phenomenons (unlisted in the summaries of product characteristics) were associated with exposure to drugs for which Raynaud phenomenons are published (interferons, ribavirin, gemcitabine) or for which Raynaud phenomenons are not published (hepatitis B vaccine, isotretinoin, leflunomide, hydroxycarbamide, rofecoxib, telmisartan, zolmitriptan). CONCLUSION The case/non-case method is usually used to generate signals. Further epidemiological studies are now necessary to confirm these findings.
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Affiliation(s)
- Émilie Bouquet
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France.
| | - Geoffrey Urbanski
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Christian Lavigne
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Pascale Lainé-Cessac
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France
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Ogawa T, Okiyama N, Koguchi-Yoshioka H, Fujimoto M. Taxane-induced scleroderma-like skin changes resulting in gangrene: A case report. J Dermatol 2016; 44:e54-e55. [PMID: 27600439 DOI: 10.1111/1346-8138.13569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tatsuya Ogawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Khouri C, Blaise S, Carpentier P, Villier C, Cracowski J, Roustit M. Drug-induced Raynaud's phenomenon: beyond β-adrenoceptor blockers. Br J Clin Pharmacol 2016; 82:6-16. [PMID: 26949933 PMCID: PMC4917788 DOI: 10.1111/bcp.12912] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/12/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022] Open
Abstract
AIM Drug-induced Raynaud's phenomenon (RP) has long been associated with the use of different drugs, including cancer chemotherapy or β-adrenoceptor blockers. However, sources report extremely variable prevalence and the level of evidence for each class is heterogeneous. Moreover, new signals are emerging from case reports and small series. Our objective was therefore to review available evidence about this adverse drug effect and to propose a mechanistic approach of drug-induced RP. METHODS A systematic review of English and French language articles was performed through Medline (1946-2015) and Embase (1974-2015). Further relevant papers were identified from the reference lists of retrieved articles. RESULTS We identified 12 classes of drugs responsible for RP, with a variety of underlying mechanisms such as increased sympathetic activation, endothelial dysfunction, neurotoxicity or decreased red blood cell deformability. Cisplatin and bleomycin were associated with the highest risk, followed by β-adrenoceptor blockers. Recent data suggest a possible involvement of tyrosine kinase inhibitors (TKI), through an unknown mechanism. CONCLUSION Drug-induced RP is a probably underestimated adverse drug event, with limited available evidence regarding its prevalence. Although rare, serious complications like critical digital ischaemia have been reported. When these treatments are started in patients with a history of RP, careful monitoring must be made and, if possible, alternative therapies that do not alter peripheral blood flow should be considered.
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Affiliation(s)
- Charles Khouri
- Pôle Santé Publique, PharmacovigilanceCHU Grenoble‐AlpesF‐38000Grenoble
| | - Sophie Blaise
- HP2Univ. Grenoble AlpesF‐38000Grenoble
- HP2INSERMF‐38000Grenoble
- CHU Grenoble‐Alpes, Clinique de Médecine VasculaireF‐38000Grenoble
| | | | - Céline Villier
- Pôle Santé Publique, PharmacovigilanceCHU Grenoble‐AlpesF‐38000Grenoble
| | - Jean‐Luc Cracowski
- HP2Univ. Grenoble AlpesF‐38000Grenoble
- HP2INSERMF‐38000Grenoble
- Pôle Recherche, Pharmacologie Clinique Inserm CIC1406CHU Grenoble‐AlpesF‐38000GrenobleFrance
| | - Matthieu Roustit
- HP2Univ. Grenoble AlpesF‐38000Grenoble
- HP2INSERMF‐38000Grenoble
- Pôle Recherche, Pharmacologie Clinique Inserm CIC1406CHU Grenoble‐AlpesF‐38000GrenobleFrance
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Yamada Y, Suzuki K, Nobata H, Kawai H, Wakamatsu R, Miura N, Banno S, Imai H. Gemcitabine-induced hemolytic uremic syndrome mimicking scleroderma renal crisis presenting with Raynaud's phenomenon, positive antinuclear antibodies and hypertensive emergency. Intern Med 2014; 53:445-8. [PMID: 24583433 DOI: 10.2169/internalmedicine.53.1160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman who received gemcitabine for advanced gallbladder cancer developed an impaired renal function, thrombocytopenia, Raynaud's phenomenon, digital ischemic changes, a high antinuclear antibody titer and hypertensive emergency that mimicked a scleroderma renal crisis. A kidney biopsy specimen demonstrated onion-skin lesions in the arterioles and small arteries along with ischemic changes in the glomeruli, compatible with a diagnosis of hypertensive emergency (malignant hypertension). The intravenous administration of a calcium channel blocker, the oral administration of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker and the transfusion of fresh frozen plasma were effective for treating the thrombocytopenia and progressive kidney dysfunction. Gemcitabine induces hemolytic uremic syndrome with accelerated hypertension and Raynaud's phenomenon, mimicking scleroderma renal crisis.
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Affiliation(s)
- Yuichiro Yamada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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[Critical limb ischemia in systemic sclerosis]. Z Rheumatol 2012; 71:261-9. [PMID: 22538844 DOI: 10.1007/s00393-011-0914-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Vascular complications are common in systemic sclerosis (SSc). Critical limb ischemia leading to gangrene or amputation occurs in more than 10% of these patients and hence is a common emergency. This report highlights the different pathogenetic mechanisms leading to critical ischemic events and provides guidance for the diagnosis and therapy. Apart from SSc-associated vasculopathy and peripheral arterial disease, thromboembolic events and rarely also vasculitis may cause critical limb ischemia. An interdisciplinary approach to the diagnosis and therapy of these lesions is mandatory. Therapy goals are the prevention of further ischemia and, if possible, revascularization as well as optimal pain management.
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