title: Liver toxicity during temozolomide chemotherapy caused by Chinese herbs.
abstract: BACKGROUND
  Complementary and alternative medicine is often used by patients with malignant glioma. Although several interactions of various alternative agents with chemotherapy are known, none has been described for temozolomide so far.
  
  
  METHODS
  We report the case of severe liver toxicity with jaundice during radiochemotherapy with temozolomide likely due to interaction with a popular Chinese herbal formula after surgery for glioblastoma. After cessation of the herbal formula as well as the chemotherapy liver enzymes slowly normalized. Due to tumor progression the patient was retreated with temozolomide for 5 cycles without toxicity. Because of further progression combination treatment of bevacizumab and irinotecan was started and again no liver toxicity was observed.
  
  
  CONCLUSIONS
  We conclude that the observed toxicity with jaundice was probably caused by an interaction of this popular Chinese formula and temozolomide. This is the first report about a relevant interaction of temozolomide and any herbal formula.
authors.forename: Thomas
authors.initials: T
authors.lastname: Melchardt
authors.forename: Teresa
authors.initials: T
authors.lastname: Magnes
authors.forename: Lukas
authors.initials: L
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Grundbichler
authors.forename: Michael
authors.initials: M
authors.lastname: Strasser
authors.forename: Clemens
authors.initials: C
authors.lastname: Hufnagl
authors.forename: Martin
authors.initials: M
authors.lastname: Moik
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
authors.affiliation: Department of Internal Medicine III, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Austria, Müllner-Hauptstrasse 48, Salzburg 5020, Austria. a.egle@salk.at.
authors.forename: Alexander
authors.initials: A
authors.lastname: Egle
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000188:drug therapy*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D004365:Drugs, Chinese Herbal / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy*; D041743:Herb-Drug Interactions; D006801:Humans; D000077146:Irinotecan; D008099:Liver / Q000473:pathology*; D008875:Middle Aged; D008517:Phytotherapy / Q000009:adverse effects; D000077204:Temozolomide
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D018906:Antineoplastic Agents, Alkylating; D004365:Drugs, Chinese Herbal; D000068258:Bevacizumab; D000077146:Irinotecan; D003606:Dacarbazine; D002166:Camptothecin; D000077204:Temozolomide