[Cholestasis following use of fenbendazole as alternative cancer treatment].

Area of Science:

• Hepatology
• Oncology
• Pharmacology

Background:

• Alternative cancer treatments lack robust efficacy data.
• Fenbendazole, a veterinary anti-helminthic, has been anecdotally linked to human liver injury, including cholangitis and liver failure.
• Cholangitis is a rare but serious adverse event associated with cancer immunotherapy.

Purpose of the Study:

• To report a case of fenbendazole-induced liver injury in a cancer patient receiving immunotherapy.
• To emphasize the importance of identifying alternative medicine use in patients presenting with unexplained toxicities.

Main Methods:

• A case report of a cancer patient admitted with cholestatic liver injury two weeks post-immunotherapy.
• Clinical evaluation, laboratory tests, magnetic resonance cholangiopancreatography (MRCP), and liver biopsy were performed.
• Patient history revealed daily intake of fenbendazole as an alternative cancer treatment.

Main Results:

• The patient presented with a tenfold increase in cholestatic parameters, normal liver enzymes (ASAT/ALAT), and bilirubin.
• MRCP showed focal inflammation, and liver biopsy revealed lobular and portal inflammation.
• Cholestatic parameters normalized spontaneously two weeks after fenbendazole discontinuation.
• Subsequent immunotherapy rechallenge was well-tolerated.

Conclusions:

• Fenbendazole should be considered a potential cause of drug-induced liver injury, specifically cholangitis, in cancer patients.
• Inquiring about the use of alternative cancer treatments is crucial for accurate diagnosis and management of treatment-related toxicities.
• Prompt identification and cessation of fenbendazole can lead to recovery from liver injury.