1 Division of Respiratory Medicine, Tsukuba Gakuen Hospital 2 Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan
*E-mail: hirosato@md.tsukuba.ac.jp
Gemcitabine and vinorelbine are indicated for the treatment of patients with inoperable non-small-cell lung carcinoma [1, 2]. We report fatal hepatic failure due to the combination of these two antitumor drugs in a patient with large cell carcinoma of the lung.
A 57-year-old man was admitted for a nodular lesion in the left lung noted on a chest X-ray. He had had laryngeal carcinoma 1 year previously, which was successfully treated with irradiation. He had no prior medical history of hepatic disease. A chest CT (computed tomography) scan showed a 4 cm nodule in the left lower lobe with bulky mediastinal lymph node swelling. Bronchoscopic biopsy revealed large cell carcinoma. Distant metastasis was not found, except for in lumbar bone. His liver function was normal. Subsequently, he was treated with gemcitabine 800 mg/m2 and vinorelbine 20 mg/m2 (days 1 and 8).
Ten days later, routine biochemical studies revealed abrupt elevation of serum alanine and aspartate aminotransferase concentrations to >1000 IU/l. Total bilirubin rose to 14.5 mg/dl (direct bilirubin 10.5 mg/dl). Abdominal ultrasonography showed neither dilated bile ducts nor intra-/extra-hepatic mass, which proved non-obstructive jaundice. Echocardiography ruled out heart failure. Viral markers for hepatitis were all negative. Because of his poor condition, liver biopsy was not performed. He died as a result of rapidly progressive hepatic failure 26 days after the initiation of the combined chemotherapy. Autopsy was not permitted.
The main side-effect of these two antitumor drugs is myelosuppression. Congestive heart failure and pulmonary toxicity have also been reported [3]. It is well known that gemcitabine does not have severe toxicity; however, cases of liver injury that developed after treatment with gemcitabine were recently reported [4, 5]. Fatal hepatic failure related to the combination of gemcitabine and vinorelbine has not previously been reported. The mechanism by which these two drugs may cause liver damage is not known. Regardless of the mechanism, however, physicians treating patients with these antitumor drugs should be alert to the possibility of fatal hepatic failure during the therapy.
K. Kagohashi1, Y. Funayama1, H. Satoh2* & K. Sekizawa2
1Division of Respiratory Medicine, Tsukuba Gakuen Hospital and 2Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan (*E-mail: hirosato@md.tsukuba.ac.jp)
References
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