Pancreatic Neuroendocrine Tumor (pNET) Showing Remission after Tuberculostatic Treatment – An Unusual Case Report Suggesting Anti-Proliferative Effects of Antibiotics in pNETs

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Introduction: Several classes of antibiotics have been associated with anti-proliferative effects on cancer cells; however, there is no data on this regarding pNETs.

Aim(s): To report an interesting case suggesting potential anti-tumor effects of antibiotics in pNET.

Materials and methods: A 44 year-old male patient presented with a pancreatic lesion and hepatic masses suspicious for metastasized pancreatic cancer. Liver biopsy revealed a NET G2 (Ki67 7%) with immunohistochemistry compatible with the pancreatic primary. Gallium-68-DOTANOC PET/CT confirmed somatostatin-receptor (SSR) positive disease. In August 2018, lanreotide 120 mg q4 weeks was started. Subsequent controls showed stable disease, but a scan performed after 11 months of treatment revealed new cavernous lung lesions without SSR expression suggestive for tuberculosis. PCR of the sputum was positive for mycobacteria. In view of attested rifampicin-resistance, a multi-drug-resistant antibiotic regimen including levofloxacin, linezolid, terizidone, clofazimine and amikacin (switched to ethambutol) was initiated. The treatment lasted for 8 weeks but was finally stopped due to the lack of further positive cultures.

Conference: 17th Annual ENETSConcerence (2020)

Presenting Author: Kiesewetter B

Authors: Kiesewetter B, Lagler H, Mazal P, Kretschmer-Chott E, Haug A,

Keywords: pancreatic neuroendocrine tumors, treatment, somatostatin analogs, antibiotics, lanreotide,