Hepatotoxicity by combination treatment of temozol

Authors: Thomas Efferth Ursula Schöttler Sanjeev Krishna Peter Schmiedek Frederik Wenz Frank A Giordano

Publish Date: 2016/08/12

Volume: 91, Issue: 4, Pages: 1833-1846

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Abstract

Glioblastoma multiforme GBM represents an aggressive tumor type with poor prognosis The majority of GBM patients cannot be cured There is high willingness among patients for the compassionate use of nonapproved medications which might occasionally lead to profound toxicity A 65yearold patient with glioblastoma multiforme GBM has been treated with radiochemotherapy including temozolomide TMZ after surgery The treatment outcome was evaluated as stable disease with a tendency to slow tumor progression In addition to standard medication ondansetron valproic acid levetiracetam lorazepam clobazam the patient took the antimalarial drug artesunate ART and a decoction of Chinese herbs Coptis chinensis Siegesbeckia orientalis Artemisia scoparia Dictamnus dasycarpus In consequence the clinical status deteriorated Elevated liver enzymes were noted with peak values of 238 U/L GPT/ALAT 226 U/L GOT/ASAT and 347 U/L γGT respectively After cessation of ART and Chinese herbs the values returned back to normal and the patient felt well again In the literature hepatotoxicity is well documented for TMZ but is very rare for ART Among the Chinese herbs used Dictamnus dasycarpus has been reported to induce liver injury Additional medication included valproic acid and levetiracetam which are also reported to exert hepatotoxicity While all drugs alone may bear a minor risk for hepatotoxicity the combination treatment might have caused increased liver enzyme activities It can be speculated that the combination of these drugs caused liver injury We conclude that the compassionate use of ART and Chinese herbs is not recommended during standard radiochemotherapy with TMZ for GBM

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