Shiina Nobumitsu, Fujisaki Kaoru, Miyoshi Tetsutaro, Yokomizo Jissei, Sai Gyokusen, Wakabayashi Yasuo, Ootsubo Yoshihisa
Dept. of Breast Surgery, Inoue Memorial Hospital.
Gan To Kagaku Ryoho. 2021 Aug;48(8):1061-1063.
A 70s woman with pancreatic metastases of HER2-negative breast cancer was being treated with bevacizumab plus paclitaxel. Tumor markers decreased after treatment initiation. After 8 months of treatment, the patient developed abdominal pain and distention, along with loss of appetite. Contrast-enhanced abdominal CT scan images showed the presence of a large 25 cm pseudopancreatic cyst and disappearance of the pancreatic metastatic lesions. Endoscopic ultrasound-guided cystogastrostomy was performed and an AXIOS stent was placed in the lower part of the gastric body. Subsequently, the cyst disappeared and her abdominal symptoms improved. The patient was able to resume treatment with other drugs and did not experience any recurrence of pancreatitis. Four months later, the AXIOS stent was removed. Bevacizumab plus paclitaxel is reportedly effective against HER2-negative metastatic breast cancer. Bevacizumab is a molecular targeted therapy against vascular endothelial growth factor, and the mechanism of its antitumor effect and complications are different from those of conventional drugs. Paclitaxel has also been reported to cause pancreatitis in rare cases. In this case, the mechanism of response to bevacizumab plus paclitaxel for metastatic pancreatic lesions or the development of drug-induced pancreatitis was considered to be the cause of pseudopancreatic cyst formation.
一名患有HER2阴性乳腺癌胰腺转移的70多岁女性正在接受贝伐单抗联合紫杉醇治疗。治疗开始后肿瘤标志物下降。治疗8个月后，患者出现腹痛、腹胀及食欲不振。腹部增强CT扫描图像显示存在一个25厘米的巨大假性胰腺囊肿，胰腺转移病灶消失。进行了内镜超声引导下囊肿胃造口术，并在胃体下部放置了AXIOS支架。随后，囊肿消失，腹部症状改善。患者能够恢复使用其他药物治疗，且未出现胰腺炎复发。4个月后，移除了AXIOS支架。据报道，贝伐单抗联合紫杉醇对HER2阴性转移性乳腺癌有效。贝伐单抗是一种针对血管内皮生长因子的分子靶向治疗药物，其抗肿瘤作用机制和并发症与传统药物不同。也有报道称紫杉醇在罕见情况下会引起胰腺炎。在本病例中，转移性胰腺病灶对贝伐单抗联合紫杉醇产生反应或发生药物性胰腺炎的机制被认为是假性胰腺囊肿形成的原因。
