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Abstract
IntroductionThere are no known case reports of hepatic steatosis caused by oral fluoropyrimidines such as capecitabine. With increasing use of capecitabine since its approval for the treatment of metastatic colon cancer in 2001, and more recently for adjuvant treatment of colon cancer and treatment of metastatic breast cancer, we can anticipate increased recognition of potential toxicities associated with this 5-fluorouracil derivative.Case presentationWe report the case of a 74-year-old Armenian woman who received capecitabine as adjuvant treatment for colon cancer and subsequently developed abnormal liver biochemical tests and radiographic findings in keeping with hepatic steatosis. There was complete reversal of liver enzyme abnormalities with discontinuation of the drug and this patient represents a case of reversible liver injury due to capecitabine.ConclusionIn this original case report, capecitabine use was associated with hepatic steatosis. It is important for clinicians to recognize and monitor for this potential toxicity, which may be a cause of abnormal liver enzymes in this patient population.
Highlights
There are no known case reports of hepatic steatosis caused by oral fluoropyrimidines such as capecitabine
In this original case report, capecitabine use was associated with hepatic steatosis
It is important for clinicians to recognize and monitor for this potential toxicity, which may be a cause of abnormal liver enzymes in this patient population
Summary
Capecitabine is an orally administered precursor of 5-fluorouracil (5-FU), a fluoropyrimidine antimetabolite. A mild manifestation of nonalcoholic fatty liver disease (NAFLD), may occur after treatment with 5-FU. Baseline liver enzymes and bilirubin were normal (AST 11 U/L [normal < 35 U/L], ALT 7 U/L [normal < 40 U/L], bilirubin 7 μmol/L [normal < 22 μmol/L]) and pre-treatment staging investigations including magnetic resonance imaging (MRI) of liver (performed due to CT contrast allergy) demonstrated no evidence of metastatic disease. Diarrhea with the first cycle, with dose reduction to 750 mg/m2 twice daily, which was well tolerated Her transaminases started to rise after the third cycle of capecitabine (AST 44 U/L, ALT 57 U/L, bilirubin 18 μmol/L), with further elevation as well as mildly increased bilirubin after the fourth cycle (AST 73 U/L, ALT 101 U/L, bilirubin 24 μmol/L). Transaminases and bilirubin remain normal after the first rechallenge cycle (AST 30 U/L, ALT 41 U/L, bilirubin 9 μmol/L)
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