title: Acute liver failure and seizures as a consequence of regorafenib exposure in advanced rectal cancer.
abstract: BACKGROUND
  Regorafenib is a multi-targeted tyrosine kinase inhibitor approved for use in refractory colorectal cancer. We report the first case of seizures secondary to acute liver failure, shortly after initiation of regorafenib in a patient with advanced rectal carcinoma.
  
  
  METHODS
  A 64 year-old Caucasian female presented with confusion and generalized tonic-clonic seizures, 5 days after initiation of regorafenib for advanced rectal cancer. Investigations revealed significant elevations in bilirubin and alanine aminotransferase. No other cause for seizures and liver dysfunction were found. After interruption of regorafenib, no further seizures occurred, the symptoms of confusion resolved and liver function returned to normal.
  
  
  CONCLUSIONS
  We report the first case of regorafenib-induced acute liver failure resulting in seizures. We suggest early monitoring for side effects, both clinically and biochemically after initiation of regorafenib.
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. soundouss.raissouni@gmail.com.
authors.forename: Soundouss
authors.initials: S
authors.lastname: Raissouni
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. Zarqa.Quraishi@albertahealthservices.ca.
authors.forename: Zarqa
authors.initials: Z
authors.lastname: Quraishi
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. Mohammed.A.Alghamdi@albertahealthservices.ca.|King Saud University, Riyadh, Saudi Arabia. Mohammed.A.Alghamdi@albertahealthservices.ca.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Ghamdi
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. Jose.Monzon@albertahealthservices.ca.
authors.forename: Jose
authors.initials: J
authors.lastname: Monzon
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. Patricia.Tang@albertahealthservices.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Tang
authors.affiliation: Tom Baker Cancer Centre, 1331, 29th Street, NW, Calgary, AB, T2N 4N2, Canada. mvickers@toh.on.ca.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Vickers
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D008875:Middle Aged; D010671:Phenylurea Compounds / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011725:Pyridines / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D012640:Seizures / Q000097:blood / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; C559147:regorafenib; D000410:Alanine Transaminase