Reuters Health Information (2004-07-05): Glucose intolerance predicts tamoxifen-induced hepatotoxicity
Glucose intolerance predicts tamoxifen-induced hepatotoxicity
Last Updated: 2004-07-05 11:45:02 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Glucose intolerance seems
to predict tamoxifen-induced hepatotoxicity in breast cancer patients
with preexisting liver steatosis, according to a report in the June
European Journal of Gastroenterology and Hepatology.
More than 30% of breast cancer patients who receive adjuvant
tamoxifen treatment develop nonalcoholic fatty liver disease, the
authors explain, but tamoxifen's hepatotoxic effects have not been
investigated in large studies.
Dr. Ioannis S. Elefsiniotis from Hippokration Hospital, Athens,
Greece and colleagues investigated predisposing factors for
nonalcoholic fatty liver disease in patients with breast cancer
patients who were treated with adjuvant tamoxifen therapy.
Of 60 patients, 26 (43.3%) had tamoxifen-induced hepatotoxicity and
34 (56.7%) did not, the authors report. Age, duration of treatment,
percentage of premenopausal women, and baseline liver function test
results were comparable between the two groups.
Body-mass index, baseline fasting glucose, and cholesterol and
triglyceride levels were significantly higher in women who developed
tamoxifen-induced hepatotoxicity than in women who did not, the report
Women with impaired glucose tolerance at baseline were nearly 2.5
times as likely as women without IGT to exhibit tamoxifen-induced
hepatotoxicity, the researchers note. Glucose intolerance predicted
tamoxifen-induced hepatotoxicity even after matching for body-mass
Six of 9 patients with tamoxifen-induced hepatotoxicity who
underwent liver biopsy had mild to moderate steatosis, two had
cirrhosis with ongoing liver inflammation, and one had macrovesicular
liver steatosis, the investigators report. All nine women had impaired
glucose tolerance before receiving tamoxifen.
Liver function tests normalized within 6 months in all 18 patients
with tamoxifen-induced hepatotoxicity who discontinued tamoxifen
treatment, the results indicate.
"Tamoxifen-induced hepatotoxicity is observed in a great proportion
of breast cancer patients with preexisting liver steatosis, especially
those with higher body mass index and higher glucose and lipid levels
at baseline control," the authors conclude. "Glucose intolerance before
the beginning of tamoxifen treatment seems to be a predictor of the
hepatotoxicity of the drug, unrelated to baseline body-mass index, a
finding that needs further investigation."
Eur J Gastroenterol Hepatol 2004;16:593-598.