[Hepatotoxicity with etoposide-ifosfamide combination therapy].

Area of Science:

• Oncology
• Pharmacology
• Toxicology

Background:

• Advanced bronchial carcinomas are often treated with combination chemotherapy.
• Etoposide and ifosfamide are commonly used chemotherapeutic agents.

Observation:

• Two patients receiving etoposide and ifosfamide for advanced bronchial carcinoma developed significant hepatotoxic side effects.
• Hepatotoxicity manifested as elevated direct bilirubin, decreased cholinesterase, and increased alkaline phosphatase, gamma-glutamyl transferase (gGT), and aspartate aminotransferase (GOT).

Findings:

• Hepatotoxicity occurred during and immediately post-chemotherapy.
• The liver injury was lethal in one patient and reversible in the other.
• Ifosfamide was identified as the probable cause, as it was newly introduced in both cases.
• A potential contribution from etoposide was noted due to prior liver enzyme alterations in one patient after etoposide and cisplatin treatment.

Implications:

• This case series highlights the potential for severe hepatotoxicity associated with etoposide and ifosfamide combination chemotherapy.
• Clinicians should monitor liver function closely in patients undergoing this treatment regimen.
• Further research into the specific mechanisms of ifosfamide-induced hepatotoxicity is warranted.