title: Drug-induced hepatotoxicity in cancer patients - implication for treatment.
abstract: BACKGROUND
  All anticancer drugs can cause idiosyncratic liver injury. Therefore, hepatoprotective agents assume particular importance to preserve liver function. Hepatic injury represents 10% of cases of acute hepatitis in adults; drug-related damage is still misjudged because of relative clinical underestimation and difficult differential diagnosis. Chemotherapeutic agents can produce liver toxicity through different pathways, resulting in different categories of liver injuries, but these drugs are not homogeneously hepatotoxic. Frequently, anticancer-induced hepatotoxicity is idiosyncratic and influenced by multiple factors.
  
  
  METHODS
  The aim of this paper is to perform a review of the literature regarding anticancer-induced liver toxicity. We described hepatotoxicity mechanisms of principal anticancer agents and respective dose reductions. Furthermore, we reviewed studies on hepatoprotectors and their optimal use. Tiopronin, magnesium isoglycyrrhizinate and S-Adenosylmethionine (AdoMet) demonstrated, in some small studies, a potential hepatoprotective activity.
  
  
  CONCLUSIONS
  Actually, in the literature only small experiences are reported. Even though hepatoprotective agents seem to be useful in the oncologic setting, the lack of well-designed prospective Phase III randomized controlled trials is a major limit in the introduction of hepatoprotectors in cancer patients and these kind of studies are warranted to support their use and to give further recommendations for the clinical practice.
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vincenzi
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Armento
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Spalato Ceruso
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.|b Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Catania
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Mark
authors.initials: M
authors.lastname: Leakos
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: c Clinical Pharmacology Department , Campus Bio-Medico, University of Rome , Rome , Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Minotti
authors.affiliation: a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D020011:Protective Agents / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D020011:Protective Agents
keywords: Hepatotoxicity; anticancer agents; biologic agents; hepatoprotective agents