Antineoplastics
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Antineoplastics Hepatitis: case report A 36-year-old woman with breast cancer and aXillary lymph node and spinal metastases, received doxorubicin 40mg + a fluorouracil analog ('Ftorofur') 800mg on day 1 and 8 and cyclophosphamide 150 mgj day for 11 days ('FAC' regimen) The patient experienced nausea, weakness and a slightly raised temperature followed by stomatitis and a further increase In temperature. The leucocyte count fell from 7.1 to 2.0 g j L. The patient responded to steroids + antibiotics + antlmycotlcs. Two months after the start of course 1 the patient received a second course of doxorubicin 40mg + fluorouracil analog 400mg on day 1 and cyclophosphamide 50 mgjday for 8 days. Drugs due on day 8 were missed because of a continuous fall In white blood cell count On day 16 the patient was pyretic, nauseous, was vomiting, had right upper abdominal pain and was Jaundiced. The patient responded well to prednisolone Two months after the start of course 2, the patient was re- hospitalised because of verteb ral metastatic pain. Treatment Included doxorubicin and fluorouracil analog on days 1 and 8. By days 10 and 11 , stomatitis combined with previous symptoms and a continually decreasing white blood cell count suggested drug-i nduced hepatitis. Readmi ssion in a further 2 months for hypercalcaemic symptoms necessitated diuretic, prednisolone and oral phosphate solution to maintain serum calcium levels. Chemotherapy was altered to etoposide 100mg for 4 days, but was followed by stomatitis, thrush, leucooenia and a deterioration of liver function, and the patient was subicteric. The patient died 3 months later. Ulcerous stomatitis, oesophageal candidiasIs, drug-induced hepatitis and malignant metastases Involving several vertebrae were confirmed by necropsy. The liver had no metastase s present Microscopic examination showed a distorted liver architecture with the parenchymal cells and bile capillaries displaying signs of cholestasls Baseline AST and AL T levels were 19 and 33 Uj L, respectively After Increasing dUring the first course of therapy, levels dropped to 43 and 120 Uj L. respectively, before the second course Levels peaked at 640 and 4000 Uj L, respectively , then fell to 360 and 440 UjL, respectively Other laboratory measurements of liver function showed similar changes . HBsAg was consistently negative. 0757-7277 / 88/ 0402-0005/ 0$07.00/ 0 © ADIS Press 'Hepatitis developed after combined Ftorofur [fluorouracil analog] + Adriamycin [doxorubicin] + cyclophosphamide ('FAC') medication and also after subsequent Vepesid [etoposide] monochemotherapy. · It was believed that hepatitis of this type has not been reported with cytostatic agents. The patient's death was precipitated by the drug-related process Pa takfaivi A Ge lencser E SipOS J Act a Medica Hungarrca 44 377 385 No 4 1987 REACTIONS 2 April 1988 5
Transcript of Antineoplastics
Antineoplastics Hepatitis: case report
A 36-year-old woman with breast cancer and aXillary lymph node and spinal metastases , received doxorubicin 40mg + a fluorouracil analog ('Ftorofur ') 800mg on day 1 and 8 and cyclophosphamide 150 mgj day for 11 days ('FAC' regimen) The patient experienced nausea , weakness and a slightly raised temperature followed by stomatitis and a further increase In temperature . The leucocyte count fell from 7.1 to 2.0 g j L. The patient responded to steroids + antibiotics + antlmycotlcs. Two months after the start of course 1 the patient received a second course of doxorubicin 40mg + fluorouracil analog 400mg on day 1 and cyclophosphamide 50 mgjday for 8 days. Drugs due on day 8 were missed because of a continuous fall In white blood cell count On day 16 the patient was pyretic , nauseous , was vomiting , had right upper abdominal pain and was Jaundiced . The patient responded well to prednisolone
Two months after the start of course 2, the patient was rehospitalised because of vertebral metastatic pain. Treatment Included doxorubicin and fluorouracil analog on days 1 and 8. By days 10 and 11 , stomatitis combined with previous symptoms and a continually decreasing white blood cell count suggested drug-induced hepatitis . Readmission in a further 2 months for hypercalcaemic symptoms necessitated diuretic, prednisolone and oral phosphate solution to maintain serum calcium levels. Chemotherapy was altered to etoposide 100mg for 4 days , but was followed by stomatitis , thrush, leucooenia and a deterioration of liver function , and the patient was subicteric . The patient died 3 months later. Ulcerous stomatitis, oesophageal candidiasIs, drug-induced hepatitis and malignant metastases Involving several vertebrae were confirmed by necropsy. The liver had no metastase s present Microscopic examination showed a distorted liver architecture with the parenchymal cells and bile capillaries displaying signs of cholestasls Baseline AST and AL T levels were 19 and 33 Uj L, respectively After Increasing dUring the first course of therapy, levels dropped to 43 and 120 Uj L. respectively , before the second course Levels peaked at 640 and 4000 Uj L, respectively , then fell to 360 and 440 Uj L, respectively Other laboratory measurements of liver function showed similar changes . HBsAg was consistently negative .
0757-7277 / 88/ 0402-0005/ 0$07.00/ 0 © ADIS Press
'Hepatitis developed after combined Ftorofur [fluorouracil analog] + Adriamycin [doxorubicin] + cyclophosphamide ('FAC ') medication and also after subsequent Vepesid [etoposide] monochemotherapy. · It was believed that hepatitis of this type has not been reported with cytostatic agents.
The patient's death was precipitated by the drug-related process Pa takfa ivi A Gelencser E SipOS J Acta Medica Hungarrca 44 377 385 No 4 1987
REACTIONS 2 April 1988 5
