Everolimus
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Fatal hepatitis B reactivation: case report A woman [age at reaction onset not clearly stated] developed fatal hepatitis B reactivation during treatment with oral everolimus for metastatic breast cancer. The woman started treatment with everolimus 10mg daily on 19 February 2013 in addition to exemestane. She developed grade 2 diarrhoea, fatigue, mouth sores, grade 1 liver enzyme elevation and hyperglycaemia. Everolimus was held on 6 March 2013 and restarted again on 25 March 2013 at a dose of 5mg daily. Her symptoms resolved. She showed an excellent response at a follow-up on 3 June 2013 and a new focus of metabolically active confluent lung consolidation was incidentally noted. Her everolimus was held and she developed a cough 3 days later with decreased exercise tolerance and blood-streaked sputum. She was hospitalised and diagnosed with a respiratory viral infection. She improved and was discharged within 48 hours. Her everolimus was not restarted. Twelve days post-discharge, she presented with new-onset epigastric pain, decreased appetite, nausea, dark urine, and pale stools. Examination revealed jaundice and laboratory tests showed grade 4 transaminitis. Hepatitis B virus (HBV) serologies showed acute HBV infection. Hepatitis B core total antibody and hepatitis B surface antigen were positive. HBV DNA PCR was positive. It was revealed by her family that she might have had HBV exposure from a blood transfusion in 1989. The woman was treated with tenofovir on hospital day 2. She initially showed improvement but later developed rising INR and lactate, hypoglycaemia, and hypophosphataemia, concerning fulminant hepatic failure. Her tenofovir was changed to lamivudine due to acute renal failure and rising lactate. She developed hepatorenal syndrome, encephalopathy, and multiorgan failure and died 2 weeks after admission. Author comment: "Oncologists and patients should be aware of this rare, but potentially fatal adverse event that can be seen with everolimus therapy." Teplinsky E, et al. Fatal hepatitis B reactivation due to everolimus in metastatic breast cancer: Case report and review of literature. Breast Cancer Research and Treatment 141: 167-172, No. 2, Sep 2013. Available from: URL: http:// 803095262 dx.doi.org/10.1007/s10549-013-2681-0 - USA
0114-9954/13/1477-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 9 Nov 2013 No. 1477
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