Real World Experience of Drug Induced Liver Injury in Patients Undergoing Chemotherapy

Azad, Adiba; Chang, Paul; Devuni, Deepika; Bichoupan, Kian; Kesar, Vivek; Branch, Andrea D.; Oh, William; Galsky, Matthew D.; Ahmad, Jawad; Odin, Joseph A.

doi:10.21767/2575-7733.1000047

Cited by 23 publications

(20 citation statements)

References 17 publications

(21 reference statements)

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“…Hence, some scholars proposed the use of induction chemotherapy for patients with mid‐ to late‐stage NPC to reduce the risk of metastasis . Chemotherapy has been previously shown to induce liver injuries that led to the termination of chemotherapy in some patients, thereby affecting the continuation of treatment . Hepatitis B virus infected‐patients may undergo HBV reactivation after receiving chemotherapy .…”

Section: Introductionmentioning

confidence: 99%

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma

Weng

Wei

et al. 2019

Cancer Medicine

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Purpose: To investigate the clinical characteristics of nasopharyngeal carcinoma (NPC) and a concomitant hepatitis B virus (HBV) infection, as well as the potential effects of HBV infection and antiviral therapy on prognosis. Methods: We conducted a retrospective chart review of all NPC patients from December 2010 to December 2014. After collecting medical records and conducting follow-ups on patients, a total of 876 eligible NPC patients were included. For each patient, medical records were reviewed. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis. Results: Among the 876 participants, 106 (12.1%) patients were HBV-infected patients. The hepatitis B surface antigen-positive [HBsAg(+)] group had a lower CD 4+ T cell count than the HBsAg(−) group (P = .048). Among patients with stage I/II NPC, 5-year overall survival (OS), disease-free survival (DFS), relapse-free survival, and distant metastasis-free survival (DMFS) of the HBsAg(+) group were 82.5%, 70.7%, 87.7%, and 76.6%, respectively, whereas those of the HBsAg(−) group were 91.4%, 86.0%, 93.8%, and 92.1%, respectively. Statistically significant differences in OS, DFS, and DMFS existed between both groups (P = .017, .018, and .004, respectively). The multivariate analysis indicated that HBsAg status and N stage are independent risk factors affecting OS, DFS, and DMFS of NPC patients. A statistically significant difference in 5-year DMFS existed between the antivirus (90.0%) and no-antivirus groups (70.0%) (P = .043). Conclusions: Hepatitis B virus infection is an independent risk factor for early stage NPC, which may be associated with its reduced immune functions compared to the HBsAg(−) group. Anti-HBV treatment may improve the prognosis of HBV-infected NPC patients. K E Y W O R D S antiviral therapy, hepatitis B virus, nasopharyngeal carcinoma, prognosis 542 | WENG Et al.

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Section: Introductionmentioning

confidence: 99%

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma

Weng

Wei

et al. 2019

Cancer Medicine

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“…Recent studies started to apply Hy's law to oncological patient to examine the incidence of chemotherapy-associated liver injuries in clinical settings. 16,17 However, our study, as far as we know, is the first one to integrate Hy's law to clinical pharmacy practice. Methodologically we applied a screening protocol with Microsoft Excel to identify Hy's law cases, modified from pharmacovigilance tools to adapt to clinical practice.…”

Section: Discussionmentioning

confidence: 96%

“…Some studies suggest that chemotherapy-induced liver injury can be cumulative and therefore has a higher incidence than presented in clinical trials. 17,37,38 Also, by detecting suspected DILI cases systemically, pharmacists can provide individualized and intensive pharmaceutical care for DILI patients, including medication reconciliation, causative agent determination, medication hepatoxicity evaluation and therapy optimization, patient education and so on. The necessity is clearly reflected by the identified cases in this study.…”

Section: Discussionmentioning

confidence: 99%

A simple method to identify undiagnosed drug-induced liver injury (DILI) and its application in oncology pharmacy practice

Wen

et al. 2019

J Oncol Pharm Pract

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Aims To establish a simple method to identify chemotherapy-induced liver injury among oncological patients. To evaluate current clinical approach to elevated laboratory liver test results. Methods A total of 289 patients admitted to oncology department who had systemic chemotherapy episodes for cancer treatment from 1 January 2017 to 31 December 2017 were identified. With aid of healthcare information system, Hy's law was applied to laboratory liver test results to identify potential hepatocellular drug-induced liver injury cases. Medical record review was carried out among identified patients to exclude liver dysfunction of alternative causes. Current clinical approach to elevated laboratory liver tests was evaluated through medical record review. Results Of 289 patients who were treated by systemic chemotherapies, there were 123 patients with elevated laboratory liver tests, among which 8 patients were suspected as potential Hy's law cases. After medical record review, there were two patients determined with chemotherapy-associated liver injury, caused by 5-fluorouracil, leucovorin, irinotecan, and S-1 plus paclitaxel separately. Of eight potential Hy's law cases, seven (87.5%) patients were prescribed with ≥2 kinds of liver protectants and remained treated with traditional Chinese medicine for decoction. Conclusions A reliable and simple method to identify undiagnosed drug-induced liver injury was successfully established. An annual incidence of 0.69% of chemotherapy-associated liver injury in oncology department of the setting was found.

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“…The induced injury could be accompanied by increased transaminases and cholestasis with elevated bilirubin, or a combination of both (2). Liver injury has been reported in up to 6% of patients receiving chemotherapy and suffering from underlying liver disease increases the risk of drug induced hepatotoxicity up to 18% of them that lead to a change in treatment regimen in 60% of cases (3). One of the liver injuries associated with chemotherapy or hormone therapy is non-alcoholic fatty liver or hepatosteatosis (4).…”

Section: Introductionmentioning

confidence: 99%

Effect of Chemotherapy on Fatty Liver Occurrence in Breast and Gastrointestinal Cancer Patients: A Case-Controlled Study

et al. 2020

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Background: Chemotherapy is one of the fundamental treatments for cancer patients, which has significantly improved the survival rate. Alongside its benefits, many side effects are imposed on the patient following chemotherapy. Ones is hepatotoxicity that initially develops as fatty liver and hepatic steatosis, but may progress to liver failure if the risk factors persist. Objectives: We aimed to determine the prevalence of fatty liver in breast and gastrointestinal cancer patients during and after chemotherapy and its risk factors. Methods: This cross-sectional study was performed on 140 patients undergoing chemotherapy for either breast or gastrointestinal cancer who referred to the Oncology Clinic of Birjand University of Medical Sciences in 2016 -2017. Demographic data regarding the disease and chemotherapy regimens were extracted from the patients' medical records. Before and after chemotherapy, the patients were evaluated by sonography for fatty liver. Data were imported into SPSS version 19 software and analyzed by chi-square (or Fisher test) and McNemar at the 5% significance level. Results: A total of 152 patients were enrolled in the study, of whom 85 had breast cancer and 67 had gastrointestinal cancer. Most patients were in the age group of 45 -54 years (48 cases, 31.6%). The mean Body Mass Index (BMI) was 23.17 ± 4.52. The frequency of fatty liver before and after chemotherapy increased from 2% to 46.7% in all patients (P = 0.0001). The frequency of fatty liver after chemotherapy was significantly higher in females than in males (52.4% and 34.7%, respectively, P = 0.04). There was no significant relationship between chemotherapy-induced fatty liver and age (P = 0.9), BMI (P = 0.17), history of diabetes mellitus (P = 0.2), and the presence of metabolic syndrome (P = 0.4). The highest frequency of fatty liver was observed in patients treated with AC-T, FOLFOX, and ECF with 53.5%, 42.9%, and 29.2%, respectively (P = 0.09). Conclusions:The results showed that chemotherapy was associated with a significantly increased risk of fatty liver, which was more in women than in men. However, the occurrence of the fatty liver following chemotherapy could be expected in all scenarios, regardless of diabetes, metabolic syndrome, BMI, and the age of the patients.

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Real World Experience of Drug Induced Liver Injury in Patients Undergoing Chemotherapy

Cited by 23 publications

References 17 publications

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma

A simple method to identify undiagnosed drug-induced liver injury (DILI) and its application in oncology pharmacy practice

Effect of Chemotherapy on Fatty Liver Occurrence in Breast and Gastrointestinal Cancer Patients: A Case-Controlled Study

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