Itraconazole therapy in a pancreatic adenocarcinoma patient: A case report

Our plain-English summary of Itraconazole therapy in a pancreatic adenocarcinoma patient: A case report, by N.R. Lockhart, J.A. Waddell, N.E. Schrock (Journal of Oncology Pharmacy Practice, 2016).

The study

• Authors: N.R. Lockhart, J.A. Waddell, N.E. Schrock
• Journal: Journal of Oncology Pharmacy Practice
• Published: 2016;22(3):528-32
• Type of article: Case report
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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.

© The Author(s) 2015.

In plain English

This case report describes one patient, a 64-year-old white man with Stage III pancreatic adenocarcinoma (T4, N1, M0). After radiation with capecitabine and cisplatin, his tumor was still considered unresectable, and he began palliative treatment with gemcitabine and erlotinib. He later needed emergency surgery on his neck spine. He was feverish and had low white blood cell counts after gemcitabine, and he developed disseminated histoplasmosis, a fungal infection. He was given itraconazole 200 mg by mouth daily, with a planned nine-month course, and treatment of his pancreatic cancer was put on hold. During his hospital stay he also received other antifungal drugs. When the cancer was reassessed, the tumor had shrunk, and he had a Whipple procedure to remove it. For about four years after surgery, regular scans showed no relapse or spread. Then a new lung nodule was found. On biopsy it was a Stage IIA non-small cell lung cancer, not spread of the pancreatic cancer. The authors attributed the tumor shrinkage to itraconazole blocking a cell-signaling route called the Hedgehog pathway. They wrote that much research remains to be done.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of a single patient, with a literature review in the discussion
• Who was studied: one 64-year-old white man with Stage III, T4, N1, M0 pancreatic adenocarcinoma (a 3 cm by 4 cm mass on the head of the pancreas); location and dates not stated
• Exposure: itraconazole (an azole antifungal drug), 200 mg by mouth daily, as a planned nine-month course to treat disseminated histoplasmosis; earlier treatment included radiation, capecitabine, cisplatin, gemcitabine and erlotinib. No asbestos exposure is described.
• Main results:
  • At diagnosis the cancer was staged as Stage III, T4, N1, M0, and after radiation with capecitabine and cisplatin it was still considered unresectable
  • Treatment of the pancreatic cancer was put on hold while the histoplasmosis was treated
  • When the cancer was restaged after itraconazole treatment, the tumor had shrunk, and he was considered eligible for removal by a Whipple procedure
  • During the hospital stay the patient also received other antifungal drugs listed in Table 1 (fluconazole, caspofungin, voriconazole, amphotericin B lipid complex)
  • For about four years after surgery, regular PET/CT scans showed no relapse or spread
  • A new left lower lung nodule found about four years later was a Stage IIA non-small cell lung cancer, not spread of the pancreatic cancer
• The authors' conclusion: The authors concluded that the shrinkage of the pancreatic tumor was due to itraconazole's inhibition of the Hedgehog pathway
• Limitations the authors state:
  • The authors stated that much research remains to determine whether itraconazole has a place in cancer chemotherapy

Topics

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Unresectable, Chemotherapy, Cisplatin, Capecitabine, Palliative Care, Gemcitabine, Glycoprotein.

Related studies

• Pan-cancer profiles of mesothelin (MSLN) unveil diagnostic potential and therapeutic targetability of pancreatic adenocarcinoma — M.R. Sheikh, B. Mistry, et al. (2026)
• Management of Peritoneal Metastasis in Patients with Pancreatic Ductal Adenocarcinoma — G. Wu, O.J. Standring, et al. (2025)
• Expression of Calretinin, Marker of Mesothelial Differentiation, in Pancreatic Ductal Adenocarcinoma: A Potential Diagnostic Pitfall — G. Askan, O. Basturk (2021)
• Efficacy and immunogenic effects of Tumor Treating Fields (TTFields) in preclinical models of pancreatic ductal adenocarcinoma, with and without gemcitabine/nab-paclitaxel — T. Kan, T. Haj Khalil, et al. (2026)
• Gene and MicroRNA Perturbations of Cellular Response to Pemetrexed Implicate Biological Networks and Enable Imputation of Response in Lung Adenocarcinoma — E.R. Gamazon, M.R. Trendowski, et al. (2018)
• Pyruvate Treatment Restores the Effectiveness of Chemotherapeutic Agents in Human Colon Adenocarcinoma and Pleural Mesothelioma Cells — E. Mungo, L. Bergandi, et al. (2018)

Browse return to medical research.