First case report associating gemcitabine with hypersensitivity reaction in a patient with pancreatic cancer.

is a nucleoside analogue indicated as first-line treatment for patients with locally advanced (unresectable Stage II or Stage III) or metastatic (Stage IV) adenocarcinoma of the pancreas [1]. In 1997 Burris et al. reported the results of the pivotal phase III study that showed superior clinical benefit response and improved median survival in a randomized comparison with 5-fluoracil (5-FU) and since then is widely accepted as the standard palliative treatment for pancreatic cancer [2]. Recently the Charité Onkologie (CONKO-001) study, a randomized trial of adjuvant chemotherapy in resected pancreatic cancer consisting of gemcitabine versus observation alone showed that gemcitabine significantly delayed the development of recurrent disease [3]. Therefore gemcitabine also promises to become the new standard treatment in the adjuvant setting [3]. Gemcitabine is a well-tolerated cytostatic agent with a mild toxicity profile that allows its combination with other agents [4]. Some case reports refer to gemcitabine-induced erysipeloid rash in areas of previous radiation or lymphangitis, scleroderma-like reactions, linear IgA bullous dermatosis, toxic epidermal necrolysis and Steven-Johnson syndrome [5, 6, 7, 8]. In this report, we present a case of hypersensitivity reaction in a patient with metastatic adenocarcinoma of the pancreas treated with gemcitabine. This is highly important because there are no previous case reports of gemcitabine induced hypersensitivity reaction published in English medical literature and gemcitabine remains considered the most active single agent in the treatment of resected, locally advanced as well as metastatic pancreatic cancer. The patient is a 56-year-old female with no significant past medical history (allergy to sulfa, causing rash), non smoker, who initially presented to her primary care physician in May of 2008 after experiencing abdominal discomfort associated with laughing. The physical exam was positive for tenderness in the right upper quadrant which prompted a CT scan of the abdomen. The CT revealed a 1.9x3.4x2.2 cm mass within the body of the pancreas with multiple scattered low density lesions within the pancreatic head, uncinate process and pancreatic tail ranging from several millimeters to 1.6 cm. The CT scan also showed marked irregularity and prominence of the omentum compatible with omental caking/seeding and peritoneal metastasis. Pathology review from an ultrasound guided FNA of the omentum showed metastatic adenocarcinoma, favoring pancreatic primary. The patient was staged as T3, N1 M1, and Stage IV. Cytokeratin 7 and cytokeratin 20 markers where positive, whereas estrogen receptor and transcription termination factor, RNA polymerase I (TTF-1) were negative. The patient began …