Pathophysiological mechanisms, multidimensional diagnostics and modern therapies of pruritus in pancreatic cancer: review and perspectives
DOI:
https://doi.org/10.12775/QS.2025.37.57137Keywords
pruritus, pancreatic cancer, cholestasis, autotaxin, LPA, SSRIAbstract
Introduction and purpose: Pruritus is a subjective, unpleasant sensation that leads to scratching and significantly impacts the quality of life of patients. In pancreatic cancer, its etiology is multifactorial. It can result from various mechanisms, with a particular emphasis on cholestasis, which represents the most important and frequent cause of this symptom, as well as paraneoplastic processes, neuropathic mechanisms, or side effects of therapy. The aim of this study is to analyze the mechanisms responsible for pruritus in pancreatic cancer, discuss diagnostic challenges, and review the available therapeutic methods and challenges, including bile duct decompression, the use of autotaxin inhibitors, opioid receptor antagonists, and SSRI drugs. The article is based on an analysis of the available scientific literature and cited sources.
Description of the state knowledge: Topics discussed include pathomechanisms of pruritus in pancreatic cancer include cholestatic, opioid-induced, paraneoplastic, neuropathic and pruritus caused by antineoplastic therapies. Another key topic is the diagnostic process for pruritus in pancreatic cancer patients, which involves laboratory and imaging studies, clinical dermatological assessment, and differential diagnosis. Lastly, a comprehensive therapeutic approach is addressed, consisting of causal treatment, pharmacological interventions, and supportive care.
References
1. Cevikbas F, Lerner EA. Physiology and Pathophysiology of Itch. Physiol Rev. 2020;100(3):945-982. doi:10.1152/physrev.00017.2019
2. Twycross R, Greaves MW, Handwerker H, et al. Itch: scratching more than the surface. QJM. 2003;96(1):7-26. doi:10.1093/qjmed/hcg002
3. Lidstone V, Thorns A. Pruritus in cancer patients. Cancer Treat Rev. 2001;27(5):305-312. doi:10.1053/ctrv.2001.0231
4. Anthony, Nicholas MD; Dries, Andrew MD; Scobey, Martin MD. The Six Year Itch: A Rare Presentation of Pancreatic Neuroendocrine Tumor: 587. American Journal of Gastroenterology 105():p S213, October 2010.
5. The pruritus of cholestasis - Nora V. Bergasa Published online October 6, 2005 DOI: 10.1016/j.jhep.2005.09.004
6. Ständer S, Schmelz M. Chronic itch and pain--similarities and differences. Eur J Pain. 2006;10(5):473-478. doi:10.1016/j.ejpain.2006.03.005
7. Darken RS, Bogitch R, Leonard J, et al. Brainstem glioma presenting as pruritus in children with neurofibromatosis-1. J Pediatr Hematol Oncol. 2009;31(12):972-976. doi:10.1097/MPH.0b013e3181b8701f
8. Kremer AE, van Dijk R, Leckie P, et al. Serum autotaxin is increased in pruritus of cholestasis, but not of other origin, and responds to therapeutic interventions. Hepatology. 2012;56(4):1391-1400. doi:10.1002/hep.25748
9. Yaksh T, Wallace M. Opioids, Analgesia, and Pain Management. In: Brunton LL, Hilal-Dandan R, Knollmann BC. eds. Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e. McGraw-Hill Education; 2017. Accessed December 16, 2024
10. Jones EA, Bergasa NV. Why do cholestatic patients itch?. Gut. 1996;38(5):644-645. doi:10.1136/gut.38.5.644
11. Welz-Kubiak K, Reich A. Znaczenie emolientów w codziennej pielęgnacji skóry. Forum Dermatologicum. 2016;2:20–23.
12. Szepietowski J., Reich A.: Świąd – Patomechanizm, klinika, leczenie. Poznań, 2010;11-15.
13. Antidepressants as antipruritic agents: A review Randeep Kaur , VR Sinha. 2018;28(3): 341-352. doi: 10.1016/j.euroneuro.2018.01.007
14. Mayo MJ, Handem I, Saldana S, Jacobe H, Getachew Y, Rush AJ. Sertraline as a first-line treatment for cholestatic pruritus. Hepatology. 2007;45(3):666-674. doi:10.1002/hep.21553
15. Zylicz Z, Krajnik M, Sorge AA, Costantini M. Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial. J Pain Symptom Manage. 2003;26(6):1105-1112. doi:10.1016/j.jpainsymman.2003.05.004
16. Ständer S, Böckenholt B, Schürmeyer-Horst F, et al. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol. 2009;89(1):45-51. doi:10.2340/00015555-0553
17. Larson VA, Tang O, Ständer S, Kang S, Kwatra SG. Association between itch and cancer in 16,925 patients with pruritus: Experience at a tertiary care center. J Am Acad Dermatol. 2019;80(4):931-937. doi:10.1016/j.jaad.2018.08.044
18. Bergasa NV, Alling DW, Talbot TL, et al. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann Intern Med. 1995;123(3):161-167. doi:10.7326/0003-4819-123-3-199508010-00001
19. Wu J, Lacouture ME. Pruritus Associated with Targeted Anticancer Therapies and Their Management. Dermatol Clin. 2018;36(3):315-324. doi:10.1016/j.det.2018.02.010
20. LaMotte RH (1992) Subpopulations of “nocifensor neurons” contributing to pain and allodynia, itch and alloknesis. Amer Pain Soc J 1:115–126.
21. Ensslin CJ, Rosen AC, Wu S, Lacouture ME. Pruritus in patients treated with targeted cancer therapies: systematic review and meta-analysis. J Am Acad Dermatol. 2013;69(5):708-720. doi:10.1016/j.jaad.2013.06.038
22. Turpin A, El Amrani M, Bachet JB, Pietrasz D, Schwarz L, Hammel P. Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021. Cancers (Basel). 2020;12(12):3866. doi:10.3390/cancers12123866
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Copyright (c) 2025 Jagienka Agata Włodyka, Urszula Zelik, Maria Przygoda, Wiktoria Domino, Gabriela Trestka, Sabina Adamczyk, Kamila Stępień, Joanna Śnieżna, Wojciech Florczak, Karol Dzwonnik, Jakub Dziewic
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