Antineoplastics
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Reactions 1269 - 12 Sep 2009 S Antineoplastics Fatal fibrosing cholestatic hepatitis: case report A 49-year-old man, with a history of hepatitis B virus (HBV) infection, developed fibrosing cholestatic hepatitis (FCH) [time to reaction onset not clearly stated] during cytotoxic chemotherapy for small-cell lung cancer; he subsequently died. The man received his first cycle of chemotherapy, consisting of cyclophosphamide 400 mg/m 2 and etoposide 100 mg/m 2 on days 1-3, doxorubicin [Adriamycin] 40 mg/m 2 on day 1, cisplatin 100 mg/m 2 on day 2, and vincristine 2mg on day 3. He also received pegfilgrastim prophylaxis. After his first cycle of chemotherapy, he developed grade 4 febrile neutropenia, and doses for his second cycle were reduced by 20%. For his third cycle, doses were returned to original levels. Laboratory tests during his third cycle showed an AST level of 232 UI/mL, and an ALT level of 639 UI/mL. AST and ALT levels remained elevated after his third cycle. After his fourth cycle of chemotherapy, he developed grade 4 neutropenia and thrombocytopenia and, serology indicated reactivation of HBV. The man received treatment with entecavir and methylprednisolone. Laboratory tests showed: AST level of 1879 UI/mL, ALT level of 2663 UI/mL, a total bilirubin level of 42 mg/dL, direct and indirect bilirubin levels of 37 and 5 mg/dL, respectively, and a prothrombin time of 10%. He was transferred to the ICU and underwent plasma exchange. He received treatment with vasoactive agents and piperacillin/tazobactam. One month after his last cycle of chemotherapy, he died from acute liver failure. Autopsy results showed a hepatic reaction and FCH. Author comment: "To our knowledge, this is the first reported case of FCH after conventional cytotoxic chemotherapy treatment in a patient diagnosed with a solid tumour." Ceballos-Viro J, et al. Fibrosing cholestatic hepatitis following cytotoxic chemotherapy for small-cell lung cancer. World Journal of Gastroenterology 15: 2290-2292, No. 18, 14 May 2009 - Spain 801150529 1 Reactions 12 Sep 2009 No. 1269 0114-9954/10/1269-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1269 - 12 Sep 2009
SAntineoplastics
Fatal fibrosing cholestatic hepatitis: case reportA 49-year-old man, with a history of hepatitis B virus
(HBV) infection, developed fibrosing cholestatic hepatitis(FCH) [time to reaction onset not clearly stated] duringcytotoxic chemotherapy for small-cell lung cancer; hesubsequently died.
The man received his first cycle of chemotherapy,consisting of cyclophosphamide 400 mg/m2 and etoposide100 mg/m2 on days 1-3, doxorubicin [Adriamycin]40 mg/m2 on day 1, cisplatin 100 mg/m2 on day 2, andvincristine 2mg on day 3. He also received pegfilgrastimprophylaxis. After his first cycle of chemotherapy, hedeveloped grade 4 febrile neutropenia, and doses for hissecond cycle were reduced by 20%. For his third cycle,doses were returned to original levels. Laboratory testsduring his third cycle showed an AST level of 232 UI/mL,and an ALT level of 639 UI/mL. AST and ALT levels remainedelevated after his third cycle. After his fourth cycle ofchemotherapy, he developed grade 4 neutropenia andthrombocytopenia and, serology indicated reactivation ofHBV.
The man received treatment with entecavir andmethylprednisolone. Laboratory tests showed: AST level of1879 UI/mL, ALT level of 2663 UI/mL, a total bilirubin levelof 42 mg/dL, direct and indirect bilirubin levels of 37 and5 mg/dL, respectively, and a prothrombin time of 10%. Hewas transferred to the ICU and underwent plasmaexchange. He received treatment with vasoactive agentsand piperacillin/tazobactam. One month after his last cycleof chemotherapy, he died from acute liver failure.
Autopsy results showed a hepatic reaction and FCH.Author comment: "To our knowledge, this is the first
reported case of FCH after conventional cytotoxicchemotherapy treatment in a patient diagnosed with a solidtumour."Ceballos-Viro J, et al. Fibrosing cholestatic hepatitis following cytotoxicchemotherapy for small-cell lung cancer. World Journal of Gastroenterology 15:2290-2292, No. 18, 14 May 2009 - Spain 801150529
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Reactions 12 Sep 2009 No. 12690114-9954/10/1269-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
