Crizotinib
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Fulminant liver failure: case report A 69-year-old woman developed fatal fulminant liver failure during off-label use of crizotinib for metastatic ovarian cancer. The woman, who had a history of metastatic ovarian cancer, had been receiving off-label crizotinib for 4 weeks [route and dosage not stated]. She subsequently presented to hospital with light headedness, weakness and hypotension. Physical examination revealed the following: BP 91/46 [unit not stated], HR 58 bpm, temperature 36.4°C and oxygen saturation 96%. Laboratory test results were as follows: haemoglobin 11.7 g/dL, WBC 6.3 x 109, platelets 238 x 109, direct bilirubin 2.5 mg/dL, total bilirubin 4 mg/dL, creatinine 0.8 mg/dL, ALP 233 U/L, lactate 3.3 mmol/L, ALT 4146 U/L and AST 3373 U/L. Her liver function tests had been normal prior to the initiation of crizotinib. MRI abdomen revealed heterogeneous hepatic enhancement with no enlargement of the bile duct. She was hospitalised for the management of acute hepatitis. Crizotinib was withdrawn and the woman was infused normal saline [sodium chloride]. Despite supportive measures, her liver function continued to deteriorate, leading to fulminant liver failure and encephalopathy. She was shifted to ICU. On ICU admission, she was intubated and required vasopressor support. However, she failed to improve, which prompted withdrawal of care following the family’s request. She died due to liver failure soon after. Author comment: "Crizotinib is a selective tyrosine kinase receptor inhibitor (TKI) approved by the FDA for treatment of advanced non-small cell lung cancer, however recent trials have shown promise in the treatment of ovarian cancer. ""This is one of the first cases of fulminant liver failure in a patient treated with crizotinib for recurrent ovarian cancer. " Kesler A, et al. A fatal case of crizotinib induced fulminant liver failure. Journal of Hospital Medicine 13 (Suppl. 1): No. 4, Apr 2018. Available from: URL: https:// www.journalofhospitalmedicine.com/jhospmed/article/162247/hospital-medicine/ 803432154 shm-research-innovation-and-clinical-vignettes-2018 [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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