Reducing the Risk of Tuberculosis Reactivation when Administering Everolimus for a Pancreatic Neuroendocrine Tumor: A Case Report

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Introduction: Everolimus can potentially reactivate tuberculosis (TB) through immunosuppression. This was recently reported to have occurred in a kidney transplant recipient. To date, no clear strategy has been developed for reducing the risk of TB reactivation during everolimus treatment.

Aim(s): We report a case of a pancreatic neuroendocrine tumor (pNET) in a patient with a latent tuberculosis infection (LTBI).

Materials and methods: A 70-year-old woman was diagnosed as having pancreatic cancer and liver metastases. She received chemotherapy with S-1, followed by transcatheter arterial infusion chemotherapy of the whole liver using 5-fluorouracil, but the liver metastases progressed. A needle biopsy of the liver tumor confirmed the diagnosis of NET G2. The Ki-67 labeling index was 6%. The serum gastrin level was 1370 pg/mL (normal, 37–172 pg/mL). Treatment with octreotide followed by octreotide LAR was started. However, after 10 months, positron emission tomography-computed tomography (CT) showed tumor metastasis to the sacral region and chest CT showed small nodules in the lung. Before the administration of everolimus, LTBI was confirmed by the QuantiFERON-TB Gold test, and isoniazid was therefore started simultaneously with everolimus to reduce the risk of TB reactivation.

Conference: 10th Annual ENETSConcerence (2013)

Presenting Author:

Authors: Tamura T, Nakazuru S, Sakane S, Iwasaki R, Iwasaki T,

Keywords: everolimus, NET, LTBI,