Management of hyperbilirubinaemia in pancreatic cancer patients

• Published in: European journal of cancer (1990) Vol. 94; pp. 26 - 36
• Main Authors: Álvarez, R., Carrato, A., Adeva, J., Alés, I., Prados, S., Valladares, M., Macarulla, T., Muñoz, A., Hidalgo, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2018; Elsevier Science Ltd
• Subjects: Adenocarcinoma; Chemotherapy; Diagnosis; Differential diagnosis; Disease management; Hyperbilirubinemia; Jaundice; Management; Medical diagnosis; Pancreatic adenocarcinoma; Pancreatic cancer; Patients; Pancreatic adenocarcinoma; Hyperbilirubinemia; Management
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2018.01.078

Development of hyperbilirubinaemia is common in patients with advanced pancreatic adenocarcinoma, both at diagnosis as well throughout disease evolution. For this reason, hyperbilirubinaemia determines chemotherapy treatment selection, and therefore it should be considered one of the most relevant conditions. There is very little evidence for the use of chemotherapy in this setting. This article summarises the main causes of hyperbilirubinaemia, how to treat them as well as their differential diagnosis. The current clinical evidence of the available drugs as well as the recommendations of use different combinations in the context of hyperbilirubinaemia are also reviewed. •Hyperbilirubinaemia is a frequent event both in diagnosis and during pancreatic ductal adenocarcinoma (PDAC) disease evolution.•When diagnosing it is important to distinguish between obstructive causes, parenchymal failure by hepatic tumour occupation and other causes (such as previous liver diseases or Gilbert syndrome).•In the case of obstructive cause, hyperbilirubinaemia preferable option is drainage by endoscopic retrograde cholangiopancreatography (ERCP).•Hyperbilirubinaemia is an exclusion criterion in all clinical studies of the chemotherapeutic agents commonly used in PDAC and therefore treatment recommendations arise from small phase I studies and published experiences.•Treatment recommendations should be individualised for each patient depending on the Eastern Cooperative Oncology Group performance status, previous comorbidities, bilirubin levels as well as the foreseeable evolution of bilirubin levels (whether using bile drainage or not).