Fatal cholestatic liver failure associated with gemcitabine therapy.

摘要: Drug-induced hepatotoxicity accounts for more than a third of the cases acute liver failure in United States. In complex medical conditions, diagnosis drug-induced injury may be confounding and, specifically, potential chemotherapeutic agents easily overlooked. Two fatal cholestatic have been previously reported, clearly implicating gemcitabine therapy. We report case that we think is strongly linked to use gemcitabine. This agent fluorine analog with broad-spectrum antitumor activity commonly used treatment breast, lung, prostate, and cervical cancer. The 45-year-old woman history metastatic breast cancer her spine. patient was remission two years before she presented compensated mixed hepatitis mild moderate severity. Inpatient work-up found metastases right humerus inferior pubic ramus, but none liver. Gemcitabine carboplatin therapy initiated relapse patient's enzyme elevation diminished, did not normalize start chemotherapy. She received four courses gemcitabine/carboplatin subsequently decompensated, severe hepatitis. Transjugular biopsy displayed marked cholestasis hepatocellular consistent hepatoxicity. has extensively studied oncology literature at this time thought low-risk hepatotoxin causing hepatic adaptation transient, reversible elevation, rarely leading termination solid tumors. believe therapy, particularly setting preexisting or liver, increases relative risk potentially possibly by idiosyncratic dose-dependent mechanisms. recommend careful monitoring dose adjustment patients abnormal function tests evidence until further study clarifies issue.