Regorafenib could cause sinusoidal obstruction syndrome
Motoi Takahashi1, Shigeru Harada1, Hideo Suzuki1
11 Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 2 Department of Hepatology, 3 Department of Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
Regorafenib treatment for colon cancer may cause liver failure through sinusoidal obstruction syndrome (SOS). Early detection of lactate dehydrogenase increase can help identify this adverse effect.
Area of Science:
- Hepatology
- Oncology
- Pharmacology
Background:
- Regorafenib is a multi-kinase inhibitor used in advanced cancer treatment.
- Liver failure is a potential, though not fully understood, adverse effect of regorafenib therapy.
Observation:
- A 74-year-old patient with advanced colon cancer developed jaundice and ascites after starting regorafenib.
- Elevated serum lactate dehydrogenase indicated intrahepatic hypoxia, and Doppler ultrasonography revealed decreased portal flow.
- The liver was not cirrhotic, suggesting a non-traditional cause of liver dysfunction.
Findings:
- The clinical presentation and diagnostic findings strongly suggested sinusoidal obstruction syndrome (SOS) as the cause of liver failure.
- Treatment with anticoagulants, including antithrombin III and recombinant thrombomodulin, led to improved portal flow and hepatic function.
- This case highlights a potential mechanism for regorafenib-induced liver failure via SOS.
Implications:
- SOS may be a significant pathway for regorafenib-induced liver toxicity.
- Serum lactate dehydrogenase could serve as an early biomarker for identifying regorafenib-induced liver failure.
- Understanding this mechanism can inform clinical monitoring and management of patients receiving regorafenib.
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