Itraconazole therapy in a pancreatic adenocarcinoma patient: A case report

Objective To report the case of a patient receiving itraconazole for the treatment of histoplasmosis and his subsequent reduction in pancreatic tumor size. Case summary A 64-year-old male was diagnosed with Stage III locally advanced unresectable pancreatic adenocarcinoma. The patient was administered radiation plus chemotherapy, which included cisplatin and capecitabine. Upon restaging, the patient’s tumor was again determined to be unresectable; therefore, palliative chemotherapy treatments were initiated, which included gemcitabine and erlotinib. After two gemcitabine cycles, he was admitted to the hospital because of loss of motor function due to spinal cord hemisection. After the surgery, the patient became neutropenic because of previous chemotherapy cycle and developed disseminated histoplasmosis. After he received his nine-month course of itraconazole, the pancreatic cancer was readdressed and he was then deemed to be resectable and had a Whipple procedure. Over the next several years, he showed no evidence of pancreatic metastases or relapse. Discussion Itraconazole has been shown to have many mechanisms by which it could potentially suppress tumor cell growth, which includes inhibition of the Hedgehog pathway, vascular endothelial growth factor receptor-2, and P-glycoprotein efflux pump. This azole antifungal has been studied in small patient populations with various types of cancers. Studies of basal cell carcinoma, nonsmall cell lung cancer, ovarian cancer, and malignant pleural mesothelioma have shown favorable results suggesting that more study of itraconazole is warranted to decide its clinical utility. Conclusion There would need to be much more research performed to determine if this agent had a role as a chemotherapy agent; however, health care professionals should be aware of itraconazole’s potential antineoplastic mechanisms.