Rapid Improvement in Gemcitabine-associated Thrombotic Microangiopathy After a Single Dose of Eculizumab: Case Report and Review of the Literature

We present here the case of a 39-year-old man with metastatic pancreatic carcinoma receiving chemotherapy with the combination of gemcitabine and nab-paclitaxel as part of a clinical trial. Despite an impressive response to therapy, he ultimately developed profound anasarca, renal insufficiency, pro...

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Bibliographic Details
Published in:Anticancer research 2020-07, Vol.40 (7), p.3995-4000
Main Authors: Burns, Shohei T, Damon, Lloyd, Akagi, Naomi, Laszik, Zoltan, Ko, Andrew H
Format: Article
Language:English
Subjects:
Adult
Albumins - therapeutic use
Antibodies, Monoclonal, Humanized - therapeutic use
Antimetabolites, Antineoplastic - adverse effects
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biopsy
Case reports
Chemotherapy
Complement Inactivating Agents - therapeutic use
Deoxycytidine - adverse effects
Deoxycytidine - analogs & derivatives
Fatal Outcome
Gemcitabine
Humans
Hypertension
Literature reviews
Male
Metastases
Monoclonal antibodies
Paclitaxel
Paclitaxel - therapeutic use
Pancreatic cancer
Pancreatic carcinoma
Pancreatic Neoplasms
Pancreatic Neoplasms - drug therapy
Renal insufficiency
Thrombotic Microangiopathies - chemically induced
Thrombotic Microangiopathies - drug therapy
Thrombotic microangiopathy
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Summary:We present here the case of a 39-year-old man with metastatic pancreatic carcinoma receiving chemotherapy with the combination of gemcitabine and nab-paclitaxel as part of a clinical trial. Despite an impressive response to therapy, he ultimately developed profound anasarca, renal insufficiency, progressive cytopenias, and malignant hypertension 6 months into his treatment course. The diagnosis of gemcitabine-associated thrombotic microangiopathy (G-TMA) was made based on renal biopsy, and receipt of the anti-C5 monoclonal antibody eculizumab proved successful at reversing his deteriorating clinical course and improving his laboratory parameters. This case illustrates the importance of recognizing this rare but serious complication, and highlights one potential therapeutic option that can be used in the appropriate clinical context.
ISSN:0250-7005
1791-7530
DOI:10.21873/anticanres.14393