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Vemurafenib-induced granulomatous hepatitis

Erin K Spengler1, David E Kleiner2, Robert J Fontana1

  • 1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.

Hepatology (Baltimore, Md.)
|June 24, 2016
PubMed

Insights

Vemurafenib treats BRAF V600E metastatic melanoma but can cause liver injury. This case highlights severe vemurafenib-induced granulomatous hepatitis and chronic cholestasis, emphasizing the need for monitoring protein kinase inhibitor hepatotoxicity.

Area of Science:

  • Oncology
  • Hepatology
  • Pharmacology

Background:

  • Vemurafenib is an oral chemotherapy targeting the BRAF V600E mutation in metastatic melanoma.
  • Protein kinase inhibitors (PKIs) like vemurafenib can cause side effects, including dermatologic and constitutional symptoms.
  • Hepatotoxicity is a known concern with vemurafenib, with reported mild and severe liver biochemistries abnormalities.

Observation:

  • A case of severe vemurafenib-induced granulomatous hepatitis is presented.
  • The patient developed chronic cholestasis secondary to the drug-induced liver injury.
  • This adverse event occurred despite the known risks of vemurafenib on liver function.

Findings:

  • Vemurafenib can lead to severe hepatic injury, specifically granulomatous hepatitis.
  • The liver injury may progress to chronic cholestasis, a prolonged bile flow impairment.
  • A review of other PKIs' hepatotoxicity is included for comparative analysis.

Implications:

  • Clinicians should be vigilant for signs of severe liver injury in patients treated with vemurafenib.
  • Monitoring liver function is crucial for early detection and management of vemurafenib-induced hepatotoxicity.
  • Understanding the spectrum of PKI-related liver injury aids in patient management and risk assessment.

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