A CASE OF REGORAFENIB INDUCED PANCREATITIS: A RARE ADVERSE EVENT OF TYROSINE KINASE INHIBITORS P. M. S. Justiniano, MD Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma, LA INTRODUCTION: Regorafenib is a multi-target tyrosine kinase inhibitor that may be indicated for treatment of patients with metastatic colorectal cancer, gastrointestinal stromal tumor or hepatocellular carcinoma. Acute pancreatitis is a rare adverse event of tyrosine kinase inhibitors and has been reported in <1.6% of patients during clinical trials for treatment of hepatocellular carcinoma with regorafenib. CASE: A 56 year old woman with metastatic colorectal cancer with prior partial colectomy and resection of recurrence, presented with abdominal pain four days after beginning therapy with regorafenib. Abdominal pain was described as sharp, epigastric, 9/10 in intensity, radiating to the back, and worsened with meals. She had decreased appetite and oral intake due to nausea and vomiting. She reported multiple episodes of non-bloody, non-bilious emesis. Additionally, she had loose stools without melena or hematochezia. She denied prior history of similar episodes. She did not have a history of gallstones, abdominal trauma, sick contacts or family history of pancreatitis. Denied, smoking, alcohol use or illicit drug use. Physical examination was pertinent for epigastric tenderness, without rebound, guarding, murphy’s sign or organomegaly. Laboratory studies were pertinent for elevated lipase >1000 U/L. Triglycerides, calcium and liver function tests were within normal limits. CT scan of the abdomen and pelvis with contrast showed pancreatic and peripancreatic edema. Treatment for acute pancreatitis was initiated with Lactated Ringers, anti-emetics and diet was advanced as tolerated. Regorafenib was discontinued and her symptoms improved on the third day of hospitalization, the patient was discharged in stable condition. DISCUSSION: Acute pancreatitis is most commonly precipitated by gallstones, alcohol use or other causes such as hypertriglyceridemia, hypercalcemia, or specific medications, which were ruled out in this patient. Regorafenib was considered the cause of this patient’s acute pancreatitis, given the close temporal relationship between the initiation of therapy while other causative factors were excluded. Per literature review, pancreatitis as a suspected adverse reaction of regorafenib in a patient with metastatic colorectal adenocarcinoma has not been previously reported. Acute pancreatitis is a potentially rare severe adverse event that may occur in patients starting therapy with tyrosine kinase inhibitors such as regorafenib.
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