Department of Pharmacy, Peking University First Hospital, Beijing, China.
Breast Disease Center, Peking University First Hospital, Beijing, China.
Thorac Cancer. 2021 Jun;12(12):1912-1916. doi: 10.1111/1759-7714.13986. Epub 2021 May 6.
Secondary sclerosing cholangitis (SSC) is a rare cholestatic liver disease that may have a severe clinical course. A 61-year-old woman with a history of metastasis breast cancer was admitted to our hospital for the second cycle of chemotherapy with lapatinib and vinorelbine. The patient had no reports of elevated liver function tests (LFTs) in the previous multiple chemotherapies or history of liver disease. However, the admission laboratory results showed severe cholestatic liver injury with the possibility of SSC by magnetic resonance cholangiopancreatography. Although chemotherapy was discontinued and patient was treated with hepatoprotective drugs, the LFTs did not improve and liver biopsy indicated mild injury of intrahepatic bile duct epithelium and hepatocyte. We added ursodeoxycholic acid and prednisolone to protect the liver, and laboratory data showed a response. To prevent the progression, lapatinib and vinorelbine were reintroduced and transient increases in alanine aminotransferase and γ-glutamyl transpeptidase were observed. With no evidence of viral or autoimmune liver disease, SSC induced by lapatinib and vinorelbine was diagnosed. This is the first case report of tyrosine kinase inhibitors and vinorelbine induced SSC and clinicians should be aware of the possibility of it. More case reports about this adverse drug reaction are needed to delineate optimal management.
继发性硬化性胆管炎（SSC）是一种罕见的胆汁淤积性肝病，可能具有严重的临床病程。一位 61 岁的女性，患有转移性乳腺癌病史，因接受拉帕替尼和长春瑞滨的第二周期化疗而入院。该患者在之前的多次化疗中没有肝功能检查（LFTs）升高的报告，也没有肝脏疾病史。然而，入院实验室结果显示严重的胆汁淤积性肝损伤，磁共振胰胆管成像提示可能存在 SSC。尽管停止了化疗并使用了保肝药物治疗，但 LFTs 并未改善，肝活检显示肝内胆管上皮和肝细胞轻度损伤。我们加用熊去氧胆酸和泼尼松龙进行保肝治疗，实验室数据显示有反应。为了防止进展，重新引入了拉帕替尼和长春瑞滨，观察到丙氨酸氨基转移酶和γ-谷氨酰转肽酶短暂升高。由于没有病毒性或自身免疫性肝病的证据，诊断为拉帕替尼和长春瑞滨引起的 SSC。这是首例报道的酪氨酸激酶抑制剂和长春瑞滨引起的 SSC，临床医生应意识到这种可能性。需要更多的病例报告来描述最佳的管理方法。
