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Published on: February 3, 2026
Biliary and pancreatic complications of molecular targeted therapies in cancer imaging
Francesco Alessandrino1,2, Katherine M Krajewski3,4, Sree Harsha Tirumani4
1Department of Imaging, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. Francesco_Alessandrino@dfci.harvard.edu.
Abstract:
The purpose of this review is to familiarize radiologists with the different imaging manifestations of biliary and pancreatic toxicity of molecular targeted therapies. The advent of molecular targeted therapies for cancer treatment has prompted radiologists to be familiar with these new molecules, their patterns of response, and their class-specific toxicities. While liver and bowel toxicities have been extensively reported in literature, less is known about the pathogenesis and imaging of toxicity involving the pancreatobiliary system. Biliary and pancreatic toxicity of molecular targeted therapies present with variable manifestations and varying degrees of severity, from asymptomatic liver function tests elevation to acute pancreatitis or cholecystitis. Management of these conditions depends on the clinical scenario and the severity of the findings. In this article, we will (1) present the various classes of molecular targeted therapies most commonly associated with biliary and pancreatic toxicity; (2) illustrate imaging findings of drug-associated biliary and pancreatic injuries and their possible differential diagnosis; and (3) provide a guide for management of these conditions.
Insights
Molecular targeted therapies can cause biliary and pancreatic toxicity, presenting diverse imaging findings. Radiologists need to recognize these toxicities for proper patient management.
Area of Science:
- Radiology
- Oncology
- Pharmacology
Background:
- Molecular targeted therapies (MTTs) are increasingly used in cancer treatment.
- While liver and bowel toxicities are well-documented, pancreatobiliary toxicity is less understood.
- Radiologists require updated knowledge on MTT-induced pancreatobiliary injury.
Purpose of the Study:
- To familiarize radiologists with imaging manifestations of biliary and pancreatic toxicity from MTTs.
- To review the pathogenesis and imaging features of these drug-induced injuries.
- To provide guidance on managing MTT-associated pancreatobiliary toxicity.
Main Methods:
- Review of current literature on molecular targeted therapies and their toxicities.
- Analysis of imaging findings associated with biliary and pancreatic drug toxicity.
- Categorization of MTT classes linked to pancreatobiliary adverse events.
Main Results:
- MTTs exhibit variable biliary and pancreatic toxicity, ranging from mild liver enzyme elevations to acute pancreatitis or cholecystitis.
- Specific imaging findings correlate with different classes of MTTs.
- Differential diagnoses for drug-induced pancreatobiliary injury are presented.
Conclusions:
- Familiarity with MTTs and their specific toxicities is crucial for radiologists.
- Recognizing imaging patterns of drug-induced biliary and pancreatic injury aids in timely diagnosis.
- Management strategies should be tailored to clinical presentation and injury severity.
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