Severe prolonged cholestatic hepatitis caused by exemestane

Bao, Ting; Fetting, John H.; Mumford, Laura M.; Zorzi, Jane; Shahverdi, Karineh; Jeter, Stacie C.; Herlong, Frank; Stearns, Vered; Lee, Linda

doi:10.1007/s10549-009-0576-x

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…The patient’s exemestane therapy was discontinued, and she was managed symptomatically using cholestyramine, phenobarbital, and lorazepam. 23 In each case, the total bilirubin peaked at 13.8 and 21.2 (mg/dL), respectively, and resolved approximately four months after the medication was discontinued. Both patients presented with a similar time course to the onset of signs and symptoms, but both the severity and duration of laboratory abnormalities were more significant in the previous reports than in this case.…”

Section: Discussionmentioning

confidence: 92%

“…Hepatotoxicity with AIs are rare and specific instances of exemestane induced hepatotoxicity have only been documented in two case reports. 7–12 , 22 , 23 Both instances had signs and symptoms of cholestatic liver injury after three to eight weeks of medication exposure. The first case illustrated a 65-year-old, previously healthy, Caucasian female with metastatic breast cancer who presented with skin and conjunctival jaundice and generalized pruritis after eight weeks of exemestane therapy.…”

Section: Discussionmentioning

confidence: 99%

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Exemestane induced cholestatic liver injury – A case report

Fritzsche

Indorf

Miske

et al. 2020

J Oncol Pharm Pract

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Purpose Exemestane, a steroidal aromatase inhibitor, is an important therapeutic option in the treatment of post-menopausal hormone receptor positive breast cancer. Adverse effects include hot flashes and bone loss, but rarely is hepatotoxicity reported. We report a case of exemestane induced cholestatic liver injury following exemestane initiation. Case report A now 77-year-old Caucasian female with primary biliary cirrhosis (PBC), and metastatic hormone receptor positive breast cancer originally diagnosed in 2000 who developed symptoms of pruritus, diarrhea, grade 2 transaminitis, and grade 1 hyperbilirubinemia three weeks after exemestane initiation. Management and outcome: Due to the patient’s signs and symptoms, exemestane was discontinued and the patient was continued on cholestyramine until resolution of her laboratory abnormalities. Approximately a week after discontinuation, the patient was started and maintained on anastrozole without recurrence of her symptoms. Discussion Hepatotoxicity with aromatase inhibitors have rarely been reported in clinical trials and to date, instances of exemestane induced hepatotoxicity has only been reported in two case reports. The patient’s history of primary biliary cirrhosis may be an important risk factor for the development of hepatotoxicity from exemestane.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Exemestane induced cholestatic liver injury – A case report

Fritzsche

Indorf

Miske

et al. 2020

J Oncol Pharm Pract

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“…While AI have been reported to cause minor elevation in liver enzymes, severe hepatotoxicity is rarely reported [ 3 ]. Liver injury is believed to be due to metabolic and immune-mediated damage, superimposed on individual susceptibility [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Liver injury is believed to be due to metabolic and immune-mediated damage, superimposed on individual susceptibility [ 4 ]. From this class of medication anastrozole and exemestane have been reported to cause drug-induced hepatitis [ 1 , 3 ]. Anastrozole has been specifically reported in cases of drug- induced autoimmune hepatitis [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately, 185 000 new cases of invasive breast cancer are diagnosed yearly, and at least half are eligible for therapy with AI [ 2 ]. AI are used as first-line adjuvant hormonal therapy in postmenopausal women with hormone-receptor positive breast cancer [ 3 ]. Over the past 10 years, there have been reported cases of hepatitis and autoimmune diseases resulting from AI use [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Letrozole-induced hepatitis with autoimmune features: a rare adverse drug reaction with review of the relevant literature

Gharia

Seegobin

Maharaj

et al. 2017

Oxford Medical Case Reports

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While aromatase inhibitors (AIs) have been known to cause minor elevations in liver enzymes, severe hepatotoxicity is rare. To the best of our knowledge, this is the first reported case of Letrozole-induced hepatitis with autoimmune features. A 70-year-old female with estrogen positive, invasive ductal carcinoma of the breast, presented with jaundice 3 months after starting letrozole. Hepatic transaminases were markedly elevated and her ANA and anti-smooth muscle antibody was positive. Liver biopsy featured drug-induced hepatitis. After stopping letrozole, liver tests trended back to normal within 3 weeks. She scored 9 for Roussel-Uclaf Causality Assessment Method (RUCAM). Over the last 10 years, there have been reported cases of drug-induced hepatitis secondary to AIs. We anticipate that there will be more widespread use of AIs based on recommendations from the TEXT, SOFT and extended AI trials. Therefore, physicians must be aware of this rare but life-threatening complication.

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Sex hormones and related compounds, including hormonal contraceptives

Dukes¹

2011

Side Effects of Drugs Annual

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Severe prolonged cholestatic hepatitis caused by exemestane

Cited by 6 publications

References 15 publications

Exemestane induced cholestatic liver injury – A case report

Exemestane induced cholestatic liver injury – A case report

Letrozole-induced hepatitis with autoimmune features: a rare adverse drug reaction with review of the relevant literature

Sex hormones and related compounds, including hormonal contraceptives

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