Anastrozole-Induced Liver Injury: A Pooled Analysis of 11 Published Case Reports

Anastrozole, a first-line adjuvant treatment for estrogen receptor-positive breast cancer, is generally well-tolerated but has been rarely associated with idiosyncratic liver injury. This brief report pooled and retrospectively analyzed 11 published case reports from PubMed and Web of Science. All identified patients were female, with a mean age of 70, suggesting that most reported cases were elderly white women. The latency period from drug initiation to injury was highly variable, ranging from days to years. Laboratory findings primarily indicated a hepatocellular pattern of injury, and most patients had no significant imaging abnormalities. Critically, discontinuation of anastrozole was the cornerstone of management, leading to recovery in 90% of cases, although one fatal outcome was reported. This analysis underscores that while rare, anastrozole-induced liver injury can be severe. Clinicians should be aware of this potential toxicity, monitor liver function appropriately, and discontinue the drug promptly if injury is suspected. Unfortunately, these findings are limited by the small sample size and publication bias inherent to case-report-based analyses. Further research is needed to understand the underlying mechanisms and risk factors.