Liver toxicity during temozolomide chemotherapy caused by Chinese herbs

Thomas Melchardt,Alexander Egle,Martin Moik,Richard Greil,Michael Strasser,Clemens Hufnagl,Michael Grundbichler,Lukas Weiss,Teresa Magnes

doi:10.1186/1472-6882-14-115

Thomas Melchardt, Alexander Egle + Show 7 more

Open Access

https://doi.org/10.1186/1472-6882-14-115

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Abstract

BackgroundComplementary and alternative medicine is often used by patients with malignant glioma. Although several interactions of various alternative agents with chemotherapy are known, none has been described for temozolomide so far.Case presentationWe report the case of severe liver toxicity with jaundice during radiochemotherapy with temozolomide likely due to interaction with a popular Chinese herbal formula after surgery for glioblastoma. After cessation of the herbal formula as well as the chemotherapy liver enzymes slowly normalized. Due to tumor progression the patient was retreated with temozolomide for 5 cycles without toxicity. Because of further progression combination treatment of bevacizumab and irinotecan was started and again no liver toxicity was observed.ConclusionsWe conclude that the observed toxicity with jaundice was probably caused by an interaction of this popular Chinese formula and temozolomide. This is the first report about a relevant interaction of temozolomide and any herbal formula.

Highlights

Complementary and alternative medicine is often used by patients with malignant glioma
We conclude that the observed toxicity with jaundice was probably caused by an interaction of this popular Chinese formula and temozolomide
This is the first report about a relevant interaction of temozolomide and any herbal formula

Summary

Introduction

Complementary and alternative medicine is often used by patients with malignant glioma. Conclusions: We conclude that the observed toxicity with jaundice was probably caused by an interaction of this popular Chinese formula and temozolomide. * Correspondence: a.egle@salk.at 1Department of Internal Medicine III, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Austria, Müllner-Hauptstrasse 48, Salzburg 5020, Austria Full list of author information is available at the end of the article scale of 90% after resection without neurological deficiencies and was referred to our department for further treatment with radiotherapy and temozolomide (TEM).

Results

Conclusion