Toremifene-induced fatty liver and NASH in breast cancer patients with breast-conservation treatment.
We have described fatty liver, diagnosed by computed tomography scanning (CT) in more than 30% of patients with breast cancer who received tamoxifen. Therefore, it is urgent to elucidate the frequency and the degree of fatty liver induced by toremifene, an analogue of tamoxifen, which is also used in breast cancer. We enrolled 52 breast cancer patients who were treated with breast-conservation treatment and administered oral toremifene for 3-5 years as adjuvant endocrine therapy. We evaluated the degree of fatty liver by abdominal CT performed annually. CT demonstrated toremifene-induced fatty liver in four (7.7%) of 52 breast cancer patients. Toremifene-induced fatty liver did not correlate with abnormal levels of AST, ALT, GGT or total cholesterol. One patient who demonstrated moderate fatty liver by CT was histologically diagnosed as non-alcoholic steatohepatitis (NASH) by liver biopsy. The incidence of toremifene-induced fatty liver was significantly lower than that induced by tamoxifen. Accordingly, in terms of fatty liver and NASH, toremifene is considered to be more appropriate agent than tamoxifen. Though toremifene is less likely to induce fatty liver, the possibility remains that toremifene-induced steatohepatitis occurs. Because the diagnosis of fatty liver or NASH can be easily missed if only a blood test is performed, it is necessary to screen fatty liver by annual CT examination for patients who receive an antiestrogen agent.
Hamada
N
N
Department of Radiology, Chikamori Hospital, Kochi 780-8522, Japan.
Ogawa
Y
Y
Saibara
T
T
Murata
Y
Y
Kariya
S
S
Nishioka
A
A
Terashima
M
M
Inomata
T
T
Yoshida
S
S
D000410:Alanine Transaminase / Q000097:blood; D000428:Alcohol Drinking / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D001629:Bezafibrate / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology / Q000209:etiology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004317:Doxorubicin / Q000008:administration & dosage*; D020847:Estrogen Receptor Modulators / Q000009:adverse effects* / Q000627:therapeutic use; D005234:Fatty Liver / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000201:enzymology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D017312:Toremifene / Q000009:adverse effects* / Q000627:therapeutic use
D018931:Antineoplastic Agents, Hormonal; D020847:Estrogen Receptor Modulators; D013629:Tamoxifen; D017312:Toremifene; D004317:Doxorubicin; D003520:Cyclophosphamide; D002784:Cholesterol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D005472:Fluorouracil; D001629:Bezafibrate