Sorafenib, an oral multi-target
tyrosine kinase inhibitor (MTKI) for
treatment of radioiodine-refractory differentiated
thyroid cancer can induce acute or
chronic pancreatitis as an
adverse event. However, there have been no
reports of
pancreatic cancer associated with MTKI, especially among long-term MTKI user. A 60-year-old
male patient visited our
outpatient cancer clinic due to aggravated abdominal and
back pain. He had been taking
sorafenib for over five years for advanced
thyroid cancer with multiple
lung metastases, without any adverse events except mild
hand-foot syndrome and slightly increased
liver enzymes at the initial phase.
Laboratory findings showed increasing
serum amylase and
lipase levels. An abdominal CT scan showed a 5.2 cm heterogeneous hypointense mass-like lesion on the
pancreas distal body area. Under suspicion of
pancreatic cancer, extensive
surgery of distal
pancreatectomy, unilateral
nephrectomy, and unilateral
adrenalectomy confirmed moderately differentiated
adenocarcinoma with a background of
chronic pancreatitis accompanying
fibrosis and
fat necrosis.
Pancreatic cancer should be considered as well as
pancreatitis in long-term MTKI users
who show abrupt increases in
serum pancreatic
enzymes, although a causal relationship between long-term MTKI use and
pancreatic cancer has not been elucidated.