title: Fatal liver failure after the administration of raltitrexed for cancer chemotherapy: a report of two cases.
abstract: BACKGROUND
  Acute fatal liver failure is a relatively rare event after the administration of antineoplastic drugs. To the authors' knowledge, there have been no published reports of this phenomenon after the administration of the widely applied cytotoxic agent raltitrexed.
  
  
  METHODS
  The authors present two cases of fulminant fatal liver failure that occurred after the administration of raltitrexed as anticancer chemotherapy.
  
  
  RESULTS
  A female patient age 76 years and a male patient age 56 years were given raltitrexed as adjuvant treatment of colorectal carcinoma and as palliative therapy for advanced biliary carcinoma, respectively. Although the initial cycles of chemotherapy were uneventful, both patients developed fulminant liver failure with rapid deterioration of their condition after the second and sixth cycles of chemotherapy, respectively, and both died within 24 hours despite immediate hospitalization. Histologic evaluation of liver samples taken during autopsy showed signs of acute necrosis involving roughly 50% of the liver without signs of subacute liver toxicity.
  
  
  CONCLUSIONS
  To the authors' knowledge the current study is the first to demonstrate fatal liver toxicity after chemotherapy with the thymidylate synthase inhibitor raltitrexed. Clinicians should be aware of the potential acute fatal side effect of this otherwise well tolerated and widely used cytotoxic agent.
authors.affiliation: Division of Oncology, Department of Internal Medicine I, University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Raderer
authors.forename: W
authors.initials: W
authors.lastname: Fiebiger
authors.forename: F
authors.initials: F
authors.lastname: Wrba
authors.forename: W
authors.initials: W
authors.lastname: Scheithauer
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000503:physiopathology; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000964:Antimetabolites, Antineoplastic; D011799:Quinazolines; D013876:Thiophenes; C068874:raltitrexed