Glycaemic adverse drug reactions from anti-neoplastics used in treating pancreatic cancer

Abstract

Purpose: Pancreatic carcinoma is the most lethal cancer, with a 5‑year survival rate of <5%. Hyperglycemia is one of the severe adverse drug reactions (ADRs) in cancer treatment. The aim was to analyze the blood glucose‑related ADR of antineoplastics in treating pancreatic cancer.

Materials and Methods: Antineoplastic drugs were selected from Martindale‑The Complete Drug Reference (36^th edition). ADR data were extracted from VigiBase, the WHO Uppsala Monitoring Centre, and the WHO’s specialist center for drug safety.

Results: Nineteen antineoplastic drugs were selected; VigiBase provided their ADR records including total 235,625 records and 27 heading ADR items, 1348 records of glucose metabolism disorders (GMDs), and 807 records of hyperglycemia. Based on the emphasized nine antineoplastic drugs with high hyperglycemic ADR incidence, we found: fluorouracil, sorafenib and pemetrexed with high ADR record of metabolism and nutrition disorders; fludarabine and flutamide with high ADR of GMD ratio. All the hyperglycemia ratios of the 9 antineoplastics were more than 50.0%, except pemetrexed and sorafenib. Thoroughly, doxorubicin carried high absolute records and ratios in hyperglycemic conditions.

Conclusions: Pancreatic carcinoma is an aggressive malignancy typically associated with severe hyperglycemia. Furthermore, hyperglycemia is one of the severe ADRs from antineoplastics, which must be paid special attention to when treating in pancreatic carcinoma, especially doxorubicin, fluorouracil, and gemcitabine. Such real‑time monitoring or pretreatment gene test can be suggested.

Keywords: Adverse drug reaction, antineoplastic, hyperglycemia, pancreatic cancer, VigiBase