Management of hyperbilirubinaemia in pancreatic cancer patients

Álvarez, Rafael; Carrato, Alfredo; Adeva, Jorge; Alés, I.; Prados, Susana; Valladares, Manuel; Macarulla, Teresa; Muñoz, Andrés; Hidalgo, Manuel

doi:10.1016/j.ejca.2018.01.078

Cited by 8 publications

(5 citation statements)

References 52 publications

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“…Limited knowledge is available regarding appropriate chemotherapy dosing and management in patients with higher bilirubin levels. Treatment recommendations for patients with hyperbilirubinemia have been based on small phase I studies or retrospective patient series with heterogeneous study populations (4,5,8,(23)(24)(25)(26). It has been reported that an initial dose reduction is unnecessary for widely used gemcitabine or capecitabine in patients with biliary tract or pancreatic cancer after successful management of biliary obstruction, even with moderate hyperbilirubinemia (27,28).…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Niemelä¹,

Syrjälä²,

Ohtonen³

et al. 2021

Anticancer Res

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Background: The survival benefit of chemotherapy compared to best supportive care (BSC) after percutaneous transhepatic biliary drainage (PTBD) was evaluated in patients with pancreatic or biliary tract cancer. Patients and Methods: A retrospective registry study was conducted at a tertiary-level university hospital. The endpoint was survival measured from the PTBD and the initiation of chemotherapy. Results: Among 158 patients (mean age=74 years, range=43-93 years; 51.9% women), 82 (51.9%) had pancreatic cancer and 76 (48.1%) had biliary tract cancer. After PTBD, 32 (20.3%) patients received chemotherapy and had a median survival of 11.7 months; 126 (79.7%) patients received only BSC resulting in a median survival of 1.7 months. The hazard ratio for survival at 1 year for patients who received chemotherapy compared to BSC was 0.22 (95% confidence interval=0.12-0.41, p<0.001). Conclusion: After PTBD, patients with pancreatic or biliary tract cancer should be critically evaluated by an oncologist to determine whether chemotherapy is possible, as it seems to significantly improve survival compared to BSC.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Niemelä¹,

Syrjälä²,

Ohtonen³

et al. 2021

Anticancer Res

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“…In addition to BAs, chemotherapy drugs can further increase bilirubin (bile component) levels. Thus, chemotherapy-related hepatotoxicity is also one of the causes of hyperbilirubinemia [260]. Gemcitabine administration could result in increased bilirubin and transaminase levels.…”

Section: Bile Acids Affect Therapy Outcomesmentioning

confidence: 99%

“…Gemcitabine administration could result in increased bilirubin and transaminase levels. Idiosyncratic liver failure is also one of the uncommon reactions to gemcitabine [260].…”

Section: Bile Acids Affect Therapy Outcomesmentioning

confidence: 99%

“…The pharmacokinetic properties of chemotherapeutic treatments can be altered due to previously present liver dysfunction. Hyperbilirubinemia impacted paclitaxel clearance negatively in patients presenting with solid tumours [260]. Most trials exclude patients with abnormal serum liver tests, including high bilirubin levels.…”

Section: Bile Acids Affect Therapy Outcomesmentioning

confidence: 99%

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Bile Acids and Microbiota Interplay in Pancreatic Cancer

Malhotra

Palanisamy

Caparrós-Martín

et al. 2023

Cancers

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Evidence suggests the involvement of the microbiota, including oral, intra-tumoral and gut, in pancreatic cancer progression and response to therapy. The gut microbiota modulates the bile acid pool and is associated with maintaining host physiology. Studies have shown that the bile acid/gut microbiota axis is dysregulated in pancreatic cancer. Bile acid receptor expression and bile acid levels are dysregulated in pancreatic cancer as well. Studies have also shown that bile acids can cause pancreatic cell injury and facilitate cancer cell proliferation. The microbiota and its metabolites, including bile acids, are also altered in other conditions considered risk factors for pancreatic cancer development and can alter responses to chemotherapeutic treatments, thus affecting patient outcomes. Altogether, these findings suggest that the gut microbial and/or bile acid profiles could also serve as biomarkers for pancreatic cancer detection. This review will discuss the current knowledge on the interaction between gut microbiota interaction and bile acid metabolism in pancreatic cancer.

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“…Endoscopic and percutaneous drainage methods differ greatly with consideration to restoration of the enterohepatic circulation and procedure associated complications [14]. ERCP is widely considered as less invasive, and is the preferred method of PBD, with PTCD reserved for cases of ERCP failure [15]. It follows that studies with a high rate of PTCD in their PBD arm may have a higher PBD associated complication rate and therefore conclude a preference for a DS approach.…”

Section: Complication and Mortality Ratesmentioning

confidence: 99%

Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

Blacker

Lahiri

Phillips

et al. 2021

Expert Review of Gastroenterology & Hepatology

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Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in all patients suffering from obstructive jaundice before pancreatic surgery. The severity of jaundice that mandates PBD has yet to be defined. The evaluated paper examines the impact of PBD on intra-operative, and post-operative outcomes in patients initially presenting with severe obstructive jaundice (bilirubin ≥250 μmol/L). In this key paper evaluation, the impact of PBD versus a direct surgery (DS) approach is discussed. The arguments for and against each approach are considered with regards to drainage associated morbidity and mortality, resection rates, survival and the impact of chemotherapy and malnutrition. Concentrating on resectable head of pancreas tumors, this mini-review aims to scrutinize the authors' recommendations, alongside those of prominent papers in the field.

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Management of hyperbilirubinaemia in pancreatic cancer patients

Cited by 8 publications

References 52 publications

Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Bile Acids and Microbiota Interplay in Pancreatic Cancer

Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

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