title: Flutamide-associated liver toxicity during treatment with total androgen suppression and radiation therapy for prostate cancer.
abstract: OBJECTIVE
  To examine the frequency and severity of toxicity associated with flutamide inpatients treated with total androgen suppression before and during pelvic radiation therapy (RT) for prostate cancer.
  
  
  METHODS
  Sixty-five patients with T2b-T4 prostate cancer received flutamide and goserelin acetate for 4 months, with RT beginning at the 3rd month. Treatment records including liver function test (LFT) results at baseline and during treatment were reviewed and toxicities noted.
  
  
  RESULTS
  In 30 (46%) of 65 patients, flutamide was discontinued prematurely. Primary reasons included elevation in LFT levels (n=14); gastro-intestinal toxicity (n=9); decreased hemoglobin level (n=2); patient refusal (n=2); and arthralgia, rash, and malaise (n=1 each). Hepatotoxicity generally was manifest as asymptomatic transaminase level elevation. Grade 3-4 hepatotoxicity was noted in four of 65 patients. Mean aspartase aminotransferase increased from 23 (baseline) to 67 U/L (during flutamide treatment) (P<.02); mean alanine aminotransferase level increased from 26 (baseline) to 94 U/L (during flutamide treatment) (P<.005).
  
  
  CONCLUSIONS
  Flutamide toxicity was common. LFTs should be monitored during flutamide therapy. The role of flutamide in this treatment regimen may need to be reevaluated.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Rosenthal
authors.forename: D E
authors.initials: DE
authors.lastname: Linstadt
authors.forename: M H
authors.initials: MH
authors.lastname: Leibenhaut
authors.forename: E J
authors.initials: EJ
authors.lastname: Andras
authors.forename: C P
authors.initials: CP
authors.lastname: Brooks
authors.forename: D R
authors.initials: DR
authors.lastname: Stickney
authors.forename: G C
authors.initials: GC
authors.lastname: Chang
authors.forename: H B
authors.initials: HB
authors.lastname: Wolkov
authors.forename: R M
authors.initials: RM
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D004796:Clinical Enzyme Tests; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005485:Flutamide / Q000009:adverse effects* / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*; D011879:Radiotherapy Dosage
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D005485:Flutamide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase