Department of Internal Medicine E, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Ann Pharmacother. 2013 Jan;47(1):e3. doi: 10.1345/aph.1R334. Epub 2013 Jan 8.
To report a case of acute pancreatitis in a patient receiving nilotinib for chronic myelogenous leukemia (CML).
A 69-year-old man recently diagnosed with chronic phase CML received nilotinib 300 mg twice daily and was admitted with acute pancreatitis that appeared the day after the first dose. The patient had normal levels of triglycerides and denied alcohol use. Serum pancreatic enzymes were within normal limits the day before nilotinib initiation. Abdominal computed tomography demonstrated a normal liver, bile duct without stones, and findings that were consistent with focal pancreatitis. The patient's history was significant for concomitant use of enalapril and simvastatin; both have been associated with pancreatitis, but the patient had been taking these medications for at least 5 years without adverse effects. Nilotinib was immediately discontinued. Abdominal pain resolved and serum pancreatic enzymes levels returned to normal 2 weeks later.
One of the adverse effects of some tyrosine kinase inhibitors is increased levels of serum pancreatic enzymes. Accordingly, nilotinib labeling includes "high lipase levels in serum" as an adverse event. There are few case reports of acute pancreatitis associated with nilotinib in the literature and some are incomplete. We present a well-documented case of nilotinib-associated acute pancreatitis. Consistent with Badalov's new classification system for drug-induced acute pancreatitis and with the Naranjo probability scale, this case represents a possible adverse reaction of pancreatitis associated with nilotinib therapy. As rechallenge is unethical, treatment with nilotinib has not been resumed.
This case demonstrates a possible association between acute pancreatitis and nilotinib use. Although a rare phenomenon, clinicians should be alert for signs and symptoms of pancreatitis, as treatment with nilotinib for CML is becoming more common.
报告 1 例接受尼洛替尼治疗慢性髓性白血病（CML）的患者发生急性胰腺炎。
1 例 69 岁男性，近期诊断为慢性期 CML，接受尼洛替尼 300mg，每日 2 次，首次剂量后第 1 天出现急性胰腺炎。患者的甘油三酯水平正常，否认饮酒。尼洛替尼起始前 1 天血清胰腺酶在正常范围内。腹部计算机断层扫描显示肝脏正常，胆管无结石，发现与局灶性胰腺炎一致。患者有同时使用依那普利和辛伐他汀的病史；这两种药物都与胰腺炎有关，但患者已经至少 5 年没有出现不良反应。立即停止使用尼洛替尼。2 周后腹痛缓解，血清胰腺酶水平恢复正常。
一些酪氨酸激酶抑制剂的不良反应之一是血清胰腺酶水平升高。因此，尼洛替尼标签将“血清中高脂肪酶水平”列为不良反应。文献中很少有尼洛替尼相关胰腺炎的病例报告，有些报告不完整。我们提供了 1 例尼洛替尼相关急性胰腺炎的详细病例。根据巴达洛夫新的药物诱导性急性胰腺炎分类系统和 Naranjo 概率量表，该病例代表与尼洛替尼治疗相关的可能的胰腺炎不良反应。由于再挑战是不道德的，因此没有恢复尼洛替尼治疗。
该病例表明急性胰腺炎与尼洛替尼使用之间可能存在关联。尽管是一种罕见现象，但临床医生应该警惕胰腺炎的症状和体征，因为 CML 的尼洛替尼治疗越来越普遍。
