Imatinib-induced liver cirrhosis in a patient with advanced gastrointestinal stroma tumor (GIST)

Abstract

BackgroundThe use of imatinib mesylate is associated with a progression free survival of 41 months in first line treatment of metastatic or locally advanced gastrointestinal stromal tumors (GIST) and other studies approved that adjuvant imatinib treatment improves the recurrence-free survival in patients with GIST. Current recommendations include 1 year adjuvant treatment in GIST patients at risk but active studies explore different durations of treatment with an interval of up to 5 years. While the most frequent adverse events (AEs) are blood count alterations, abdominal discomfort and edema, the occurrence of grade 3 or 4 increase of AST or ALT is specified with 2.1% and 2.7% respectively.Case presentationWe report a 49-year old male with a gastrointestinal stromal tumor (GIST) of the small bowel who developed liver cirrhosis under adjuvant imatinib treatment.ConclusionsOur report supports the notion that imatinib-induced hepatotoxicity may lead to acute liver damage with subsequent cirrhotic remodelling. Patients developing grade 3 or 4 hepatotoxicity during imatinib treatment should therefore be carefully evaluated for chronic liver disease.

Pathogenesis of Primary Sclerosing Cholangitis and Advances in Diagnosis and Management

“…Imatinib has been reported to have hepatotoxic effects, and the safety of this agent in PSC patients is unknown. 160 Other agents with potential anti-fibrotic properties include angiotensin receptor blockers, colchicine, and pentoxifylline. 161, 162 However colchicine and pentoxifylline have not shown benefit in patients with PSC.…”

Multikinase inhibitor-induced liver injury in patients with cancer: A review for clinicians

“…Nevertheless, a fatal evolution despite drug withdrawal was reported for crizotinib [35,66], erlotinib [49,50,67,68], imatinib [58,72], pazopanib [63], regorafenib [46,77], sorafenib [80], and sunitinib [61,81,105]. Two cases of cirrhosis were reported after 18 and 24 months of imatinib treatment [74,106]. No other cause of liver disease was found in these patients.…”

Imatinib-induced hepatitis treated by corticosteroids in a patient with metastatic gastrointestinal stromal tumor

“…Imatinib mesylate is a selective inhibitor of the BCR-ABL tyrosine kinase, which is widely used for the treatment of chronic myelogenous leukemia, Philadelphia chromosome-positive acute lymphoblastic leukemia, and C-kit (CD 117)-positive advanced metastatic gastrointestinal stromal tumor (GIST) [1,2]. Imatinib-induced hepatotoxicity has been reported in less than 2.5% of patients with GIST [3]. Although the mechanism of imatinib-induced hepatotoxicity is unclear, it is thought to be an idiosyncratic reaction to the drug [3].…”

“…Imatinib-induced hepatotoxicity has been reported in less than 2.5% of patients with GIST [3]. Although the mechanism of imatinib-induced hepatotoxicity is unclear, it is thought to be an idiosyncratic reaction to the drug [3]. Most patients present with mild elevation of aminotransferase during first 2–3 months of imatinib treatment [4].…”

“…Most patients present with mild elevation of aminotransferase during first 2–3 months of imatinib treatment [4]. In general, imatinib-induced hepatotoxicity is improved within 4 weeks of drug discontinuation [3,4]. However, in cases of liver enzyme deterioration after the discontinuation of imatinib, corticosteroids can be used [2,5].…”