Microangiopathy associated with gemcitabine: a drug interaction with nab-paclitaxel? A case series and literature review

Allard, Jeanne; Bonnet, Mathilde; Laurent, Lucie; Benameur, M.; Gagaille, Marie-Pauline; Leclerc, Vincent

doi:10.1007/s00228-022-03324-z

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Although TMA caused by nab-paclitaxel has been rarely reported, its potential role in causing drug-induced TMA cannot be denied. A recent article suggests a potential drug interaction between nab-paclitaxel and gemcitabine thereby increasing the risk of developing gemcitabine-induced TMA ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine-induced thrombotic microangiopathy treated with eculizumab: a case report

Eeckhaut¹,

Hannon²,

Schurgers³

et al. 2022

J Gastrointest Oncol

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Background: Gemcitabine is a broadly used chemotherapeutic agent that can cause a rare but lifethreatening complication called thrombotic microangiopathy (TMA). Early recognition is crucial as therapy options are limited.Case Description: We report the case of a 46-year-old patient with pancreatic adenocarcinoma who presented with severe anemia and thrombocytopenia as well as acute kidney injury. A diagnosis of gemcitabine-induced TMA was made. He became rapidly transfusion and dialysis dependent. Despite discontinuation of gemcitabine and treatment with high-dose corticotherapy as well as plasmapheresis, no improvement in both renal and hematological parameters was seen. Treatment with eculizumab was initiated. One week after the first administration, the patient no longer required packed cells nor platelet transfusions and one month later, dialysis could be discontinued. After five doses, treatment with eculizumab was stopped. Four months later, his serum creatinine was 1 mg/dL. Conclusions: This case report illustrates the promising beneficial effects of eculizumab in gemcitabineinduced TMA, both regarding transfusion dependence as well as improvement in renal function, thereby allowing further therapy options in patients with an active malignancy.

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Section: Discussionmentioning

confidence: 99%

Gemcitabine-induced thrombotic microangiopathy treated with eculizumab: a case report

Eeckhaut¹,

Hannon²,

Schurgers³

et al. 2022

J Gastrointest Oncol

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Gemcitabine and nab-paclitaxel drug interaction?

2022

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Time to Onset of Gemcitabine-induced Thrombotic Microangiopathy in a Japanese Population: A Case Series and Large-scale Pharmacovigilance Analysis

Takigawa

Tanaka

Washiashi

et al. 2022

CDP

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Background/Aim: Gemcitabine-induced thrombotic microangiopathy (G-TMA) is associated with a high mortality rate. However, owing to its low incidence, data on G-TMA remain limited. Therefore, a detailed review of G-TMA cases is critical to understand this adverse event. In addition, reviewing literature and pharmacovigilance analytics may be useful to characterise G-TMA. Here, time to onset of G-TMA was analysed based on available data. Patients and Methods: We collected data for a case of TMA following gemcitabine administration at the Tokyo Metropolitan Geriatric Hospital. We also reviewed the literature on G-TMA cases in Japan from April 2000 to March 2022 to provide a case series. Moreover, we performed time-to-onset analysis of G-TMA using the data from the Japanese Adverse Drug Event Report (JADER) database. Results: Our case involved a patient with pancreatic cancer who developed thrombotic thrombocytopenic purpura 13 months after starting gemcitabine treatment. From the literature reviewed, in 14 out of 17 cases, G-TMA occurred 5-8 months after treatment initiation. The analysis of data from the JADER database showed that the median time to onset of G-TMA was 161 days. Weibull shape parameter analysis showed that the pattern of onset of G-TMA represented a random failure. Conclusion: This study elucidated the time to onset of G-TMA in a Japanese population. Weibull shape parameter analysis showed that G-TMA may not necessarily develop in a dose-dependent manner. These results may be useful for monitoring G-TMA in the clinical setting.

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Microangiopathy associated with gemcitabine: a drug interaction with nab-paclitaxel? A case series and literature review

Cited by 3 publications

References 34 publications

Gemcitabine-induced thrombotic microangiopathy treated with eculizumab: a case report

Gemcitabine-induced thrombotic microangiopathy treated with eculizumab: a case report

Gemcitabine and nab-paclitaxel drug interaction?

Time to Onset of Gemcitabine-induced Thrombotic Microangiopathy in a Japanese Population: A Case Series and Large-scale Pharmacovigilance Analysis

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