Pazopanib-induced mixed liver injury in a patient with soft-tissue sarcoma, but without the UGT1A1 *28 mutation: a case
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CASE REPORT
Pazopanib‑induced mixed liver injury in a patient with soft‑tissue sarcoma, but without the UGT1A1*28 mutation: a case report Manabu Hayashi1 · Kazumichi Abe1 · Masashi Fujita1 · Atsushi Takahashi1 · Yasuyuki Kobayashi2 · Yuko Hashimoto2 · Hiromasa Ohira1 Received: 10 August 2020 / Accepted: 18 September 2020 © Japanese Society of Gastroenterology 2020
Abstract A 72-year-old man who underwent pazopanib therapy for soft-tissue sarcoma in the left leg was referred to our department because of elevated levels of liver enzymes. Laboratory tests showed high alanine aminotransferase, alkaline phosphatase, and total bilirubin levels. He was treated with intravenous methylprednisolone (mPSL) therapy (125 mg/day) followed by oral prednisolone and ursodeoxycholic acid therapy, but his liver enzyme abnormality deteriorated and he presented with jaundice. The intravenous mPSL (250 mg/day) treatment was effective and the abnormal levels of liver enzymes and jaundice were improved. He does not carry the UGT1A1*28 mutant allele. Based on our findings, patients presenting with markedly increased liver enzyme levels and jaundice after pazopanib may require steroid therapy. Keywords Pazopanib · Liver injury · Jaundice · Steroid
Introduction Pazopanib is tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-KIT. Pazopanib is an effective treatment for advanced renal cell carcinoma, desmoid tumor, and soft-tissue sarcoma [1–3]. Hepatotoxicity commonly occurs in patients treated with pazopanib [4]. The incidence of elevated alanine aminotransferase (ALT) levels of all grades is reported to be 46–60% by the National Cancer InstituteCommon Toxicity Criteria for Adverse Events version 3.0, and the incidence of elevated ALT levels greater than 8 times the upper limit of normal (ULN) is 6%. The incidence of an elevated total bilirubin (TB) level greater than 2 times the ULN with an elevated ALT level greater than 3 times the ULN in pazopanib-treated patients was reported to range from 0.6 to 2.3% [5]. Liver injury with jaundice is not a common finding, and the clinical course remains unknown. * Manabu Hayashi [email protected] 1
Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960‑1295, Japan
Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
2
We report a patient who developed liver injury with jaundice after pazopanib treatment.
Case report A 72-year-old man experiencing pain, swelling, and numbness in the left leg visited the local hospital. Gadolinium contrast magnetic resonance imaging revealed a tumor in the left leg (79 × 52 × 32 mm, Fig. 1a). He was referred to the Department of Orthopedic Surgery at our hospital. Positron emission tomography-magnetic resonance imaging showed high FDG uptake by the tumor in the left leg (Fig. 1b, c). A computed tomography image revealed multiple lung metastases. He was diagn
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