Guidelines for Complications of Cancer Treatment Vol VIII Part B

Topotecan causes elevation of transaminases in fewer than10% of patients and significant elevations of liver enzymesare uncommon (19).Irinotecan can cause severe transaminitis which is oftenreversible.Usually seen in patients with hepatic metastases(20).Miscellaneous Agents:Cisplatin is a rare cause of hepatic toxicity, but minor ASTelevations are common at usual therapeutic dose. Cisplatininducedacute hepatic injury is dose related. (21).Oxaliplatin is renally eliminated and can be given to patientswith severe liver dysfunction due to metastatic colorectalcancer (22).L-asparaginase (L-Asp) hydrolyzes L-asparagine in serum.Hepatic toxicity is quite frequent with L-Asp. The mechanismof hepatotoxicity involves impaired protein synthesis fromasparagine depletion. Decreased serum levels of albumin,ceruloplasmin, haptoglobin, transferring and coagulationfactors II, VII, IX, X, and fibrinogen are common. Moderateelevations of aminotransferase, bilirubin, and alkalinephosphatase also occur. These common changes with L-Aspare usually mild and reversible (23).Bortezomib is metabolized by the liver and clearance maydecrease with hepatic impairment. Hyperbilirubinemia andportal vein thrombosis have also been reported (24).Hepatic Veno-Occlusive Disease:High-dose chemotherapy such as tin stem cell transplant mayresult in a specific pattern of hepatotoxicity known as VOD.Drugs implicated to cause this includes busulfan ,Cyclophosphamide, Carmustine (BCNU),Lomustine.466