A case of necrotic enteritis during neoadjuvant chemotherapy with gemcitabine and S-1 for resectable pancreatic ductal adenocarcinoma

• Published in: Clinical journal of gastroenterology Vol. 14; no. 5; pp. 1571 - 1577
• Main Authors: Furukawa, Takaaki, Sasaki, Takashi, Ono, Yoshihiro, Kawano, Fumihiro, Takamatsu, Manabu, Mori, Chinatsu, Mie, Takafumi, Yamada, Yuto, Okamoto, Takeshi, Takeda, Tsuyoshi, Kasuga, Akiyoshi, Matsuyama, Masato, Ozaka, Masato, Takahashi, Yu, Sasahira, Naoki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.10.2021
• Subjects: Abdominal Surgery; Case Report; Colorectal Surgery; Gastroenterology; Hepatology; Medicine; Medicine & Public Health; Surgical Oncology; Neoadjuvant chemotherapy; Necrotic enteritis; Gemcitabine; S-1; Pancreatic cancer
• ISSN: 1865-7257; 1865-7265
• DOI: 10.1007/s12328-021-01480-w

Pancreatic cancer is the fourth leading cause of cancer-related death in Japan. Pancreatic cancer is categorized as resectable, borderline resectable, or unresectable based on the degree of adjacent vascular invasion and the presence of distant metastases. Neoadjuvant chemotherapy with gemcitabine and S-1 (NAC-GS) has recently become a standard option for resectable pancreatic cancer in Japanese patients. According to previous reports, GS is considered to be relatively safe and feasible treatment for Japanese patients, including the elderly. However, NAC-GS is occasionally associated with severe adverse events which may ultimately render the patient unfit for surgery. A 60-year-old man with resectable pancreatic cancer suffered from severe necrotic enteritis during NAC-GS, which required surgical resection. Considering the time course and histological findings of the resected bowel, S-1 was believed to be the causative agent. The low urinary dihydrouracil to uracil ratio also suggested possible dihydropyrimidine dehydrogenase deficiency, which may have hindered the metabolism of S-1 and contributed to the development of necrotic enteritis. Life-threatening enteritis occurs in approximately 0.3% of all patients who receive S-1. As initial symptoms are non-specific, patients should be instructed to lower the hurdle for contacting the hospital during NAC-GS.