Drug hepatitis of cholestatic type in association with a FAC-regimen for breast cancer.
The case of a 36 year old patient in whom breast cancer was diagnosed in February 1983 is reported. At the time of the diagnosis bone metastases, were already present. Therapy was started on the basis of a FAC-regimen (Ftorofur-, Adriamycin-Cyclophosphamide), where after the patient developed clinical and laboratory signs of hepatic lesion. At the time of the first FAC-course the suspicion of viral hepatitis of cholestatic type was raised; HBsAg was consistently negative. In the 3rd week after completion of the second FAC-course clinical signs of cholestatic hepatitis with high fever and leucopenia of increasing severity were suggestive of drug-induced hepatitis. Cyclophosphamide was incriminated, therefore, this component was omitted from the subsequent FAC-course. Nevertheless, the clinical manifestations reappeared in a more pronounced form. This time, too steroids were administered, with beneficial effect. In view of the complaints pointed to bone-metastases further cytostatic treatment, Vepesid monotherapy was started, but after the first course the patient developed hepatitis and died. Necropsy revealed, in addition to extensive bone-metastases, microscopic signs of drug-induced hepatitis. The types of liver damage caused by the cytostatic agents used in this study are reviewed. No hepatitis has been reported in connection with these drugs (Adriamycin + Ftorofur or Vepesid) thus far. The diagnostic criteria of drug-induced hepatitis are outlined. It is pointed out that with the eves more extensive use of cytostatic therapy a growing incidence of this complication should be taken into account.