Prevention and treatment of drug-induced liver injury in patients with breast cancer and ovarian cancer

Abstract

Introduction: Drug-induced liver injury is one of the most serious problems in hepatology. In most cases the abolition of the “causative” drug is a sufficient condition for the reverse development of pathological changes. However, in the case of chemotherapy for cancer patients, the abolition of hepatotoxic drug is impossible without creating an immediate or delayed threat to the patient’s life. Objective: To develop optimal schemes for the prevention and treatment of drug-induced liver injury by studying of its characteristics of with various chemotherapy regimens in patients with breast cancer and ovarian cancer. Material and methods: The screening group included 291 patients who underwent chemotherapy courses for breast cancer and ovarian cancer. The diagnosis and type of drug-induced liver injury was based on laboratory data (alanine aminotransferase and/or alkaline phosphatase increased above 2 norms) and the exclusion of other etiologies of liver diseases. Chemotherapy hepatotoxicity was assessed using the Shaposhnikov scale. The degree of hepatic encephalopathy was determined using a critical flicker frequency test. Depending on chemotherapy mode, groups of the patients were divided into subgroups: cyclophosphamide + Methotrexate+ Fluorouracil, Doxorubici + Cyclophosphamide, Epirubicin + Cyclophosphamide + 5-fluorouracil, Paclitaxel + Cisplatin, Carboplatin + Cyclophosphamide. According to the type of drug-induced liver injury, patients with cholestatic type received preparations, with cytolytic type – S-adenosylmethionine for 8 weeks. Results and its discussion: It was found that the most common side effect of chemotherapy is leukopenia, anemia and increase in level of alanine aminotransferase and alkaline phosphatase. The use of ursodeoxycholic acid and S-adenosylmethionine as an accompanying therapy significantly reduces the level of alanine aminotransferase and alkaline phosphatase degree of hepatotoxicity and hepatic encephalopathy, clinical improves the quality of life of patients and contributes to a more rapid elimination of symptoms of astheno-vegetative, dyspeptic and pain syndromes. Conclusion: It has been proven that the use of a differentiated approach to the choice of a hepatoprotector: S-adenosylmethionine in hepatocellular type, ursodeoxycholic acid - in cholestatic type of drug-induced liver injury for 8 weeks in patients with oncological profile allowed to carry out the planned therapy without deviations from the protocol.