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• W2049274325 abstract "1.Recognize potential fatal liver toxicity of gemcitabine in cancer patients receiving palliative care.2.Discuss plan of care with cancer patients and their families by sharing the knowledge of potential toxicity of commonly used palliative chemotherapy. I. Background. With the increasing recognition of the value of palliative care consultation, palliative care specialists have become involved in cancer care much earlier in the disease trajectory. It is, therefore, important for the palliative care specialists to be familiar with the potential toxicities of commonly used chemotherapeutic agents. To raise awareness of potential hepatotoxicity of gemcitabine in patients receiving palliative care, we report a case of fatal liver failure as a result of gemcitabine treatment in a patient with metastatic breast cancer who was recently started on methadone. II. Case Description. A 58-year-old female with a metastatic breast cancer had received gemcitabine for 3 months. Her pain related to skeletal metastases was managed by a palliative care service. Four weeks after the last gemcitabine dose and 2 weeks after initiation of methadone, she was found to have elevated liver function tests (LFT). She had no other change in her medications. Serologic tests for viral hepatitis were negative. Imaging studies showed no hepatic or biliary lesions. Liver biopsy displayed an acute hepatitis which involved the lobules and portal zones with evidence of cholangitis and bile duct proliferation, consistent with drug toxicity. Over the next 2 weeks, her LFTs had worsened progressively, with total bilirubin elevated to 15.3 mg/dL. She also developed encephalopathy and coagulopathy requiring admission to the hospital. Despite maximal supportive care, the liver failure rapidly worsened and kidney function deteriorated. She died in multiorgan failure 4 days after the admission. III. Conclusion. Only five cases of fatal liver failure have been reported associated with the use of gemcitabine. There is no known drug interaction between gemcitabine and methadone. Gemcitabine can be a contributor to an unpredictable death in patients receiving palliative care. Improved awareness of the potential fatal toxicity of some chemotherapeutic agents may help patients and families define more realistic plan of care. Physical Aspects of Care" @default.
• W2049274325 created "2016-06-24" @default.
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• W2049274325 date "2010-02-01" @default.
• W2049274325 modified "2023-09-29" @default.
• W2049274325 title "Fatal Liver Failure due to Gemcitabine in a Patient with Metastatic Breast Cancer Receiving Palliative Care" @default.
• W2049274325 doi "https://doi.org/10.1016/j.jpainsymman.2009.11.264" @default.
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