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Diabetes/Prediabetes/Hypoglycemia

(9.02) A case of a 58-year-old man with type 2 DM who was diagnosed with pancreatic adenocarcinoma after treatment with Tirzepatide.

Friday, May 10, 2024
10:30 AM – 10:45 AM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Introduction : Tirzepatide, a novel treatment for Type 2 Diabetes Mellitus (T2DM), has shown promising results in glycemic control. However, concerns have emerged regarding its potential association with pancreatic cancer. This report explores a case of a 58-year-old man with T2DM who developed pancreatic cancer following Tirzepatide therapy, emphasizing the need to be aware and ensure the safety of this therapeutic approach.

Case(s) Description :

In October 2023, a 58-year-old man presented for a routine follow-up for T2DM. He was first diagnosed with diabetes about 20 years ago.  Having initiated Mounjaro(Tirzepatide) 5mg subcutaneous injections weekly in June 2022, the patient reported gastrointestinal symptoms by March 2023, including recurrent bloody stools, 3-4 episodes of diarrhea, and an unintentional weight loss of 20-25 pounds over two months. A CT scan on May 1, 2023, revealed numerous liver masses, with the largest measuring 18mm, and additional fluid near the spleen and liver. Subsequent abdominal MRI confirmed a large pancreatic mass and evidence of liver metastasis. Fine-needle aspiration and liver biopsy led to a Stage IV pancreatic cancer diagnosis.


The patient underwent eight cycles of chemotherapy, resulting in an overall improvement in both liver and pancreatic lesions, as confirmed by a follow-up CT scan in September 2023. Although, the prognosis remains grim. 

 

Discussion : The case raises concerns about a potential link between Tirzepatide, a GLP-1 receptor agonist, and an increased risk of pancreatic cancer. However 90% of pancreatic cancer arises in the exocrine regions and it can take several years to develop detectable pancreatic cancer.. The absence  of GLP-1 receptors in pancreatic ductal cells prompts speculation about the impact of this drug class on pancreatic carcinogenesis. Our review of literature suggests that this association is likely not causative as diabetes is an independent risk factor in the development of pancreatic cancer.  Diabetes on the other hand may be a presenting symptom of pancreatic cancer. Further research is crucial to elucidate the association of incretin based treatment modalities in the development of pancreatic cancer and guide T2DM management. Screening protocols to assist in timely diagnosis of pancreatic cancer may help in reducing morbidity and mortality. Interdisciplinary collaboration is essential for holistic care in cases of T2DM and concurrent pancreatic cancer. This report highlights the need for vigilant monitoring and exploration of the Tirzepatide-pancreatic cancer relationship.