It is well characterised that chemotherapeutic agents cause hepatotoxicity,known as chemotherapy-associated liver injury(CALI).1 This can take the form of transient elevations in liver function tests,drug-induced hepa...It is well characterised that chemotherapeutic agents cause hepatotoxicity,known as chemotherapy-associated liver injury(CALI).1 This can take the form of transient elevations in liver function tests,drug-induced hepatitis,veno-occlusive disease and steatohepatitis,as well as chronic manifestations such as fibrosis and cirrhosis.2 Three forms of CALI are recognised,including(1)chemotherapy-associated steatohepatitis(CASH)(eg,post 5-fluorouracil(5-FU)and irinotecan3);(2)nodular regenerative hyperplasia(NRH),for example,post bleomycin,cyclophosphamide and doxorubicin;however,recent literature has identified oxaliplatin as the foremost causative drug4;and(3)sinusoidal obstruction syndrome(SOS)found in over 50%of patients with CALI.5 CALI has clinically significant consequences and is associated with increased morbidity and mortality,treatment disruption and reduced tolerance of chemotherapy.6–9 Chronic sequelae can develop,and SOS and NRH are causes of non-cirrhotic portal hypertension.4 In the neoadjuvant setting,the occurrence of CALI can adversely affect surgical outcomes.This is particularly evident in the case of metastatic colorectal cancer(MCRC).展开更多
文摘It is well characterised that chemotherapeutic agents cause hepatotoxicity,known as chemotherapy-associated liver injury(CALI).1 This can take the form of transient elevations in liver function tests,drug-induced hepatitis,veno-occlusive disease and steatohepatitis,as well as chronic manifestations such as fibrosis and cirrhosis.2 Three forms of CALI are recognised,including(1)chemotherapy-associated steatohepatitis(CASH)(eg,post 5-fluorouracil(5-FU)and irinotecan3);(2)nodular regenerative hyperplasia(NRH),for example,post bleomycin,cyclophosphamide and doxorubicin;however,recent literature has identified oxaliplatin as the foremost causative drug4;and(3)sinusoidal obstruction syndrome(SOS)found in over 50%of patients with CALI.5 CALI has clinically significant consequences and is associated with increased morbidity and mortality,treatment disruption and reduced tolerance of chemotherapy.6–9 Chronic sequelae can develop,and SOS and NRH are causes of non-cirrhotic portal hypertension.4 In the neoadjuvant setting,the occurrence of CALI can adversely affect surgical outcomes.This is particularly evident in the case of metastatic colorectal cancer(MCRC).
