Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature

Publication type:
Journal article
Metadata:
Autoren
  • Thomas Efferth
  • Ursula Schoettler
  • Sanjeev Krishna
  • Peter Schmiedek
  • Frederik Wenz
  • Frank A Giordano
Autoren-URL
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=fis-test-1&SrcAuth=WosAPI&KeyUT=WOS:000398819200022&DestLinkType=FullRecord&DestApp=WOS_CPL
DOI
10.1007/s00204-016-1810-z
eISSN
1432-0738
Externe Identifier
  • Clarivate Analytics Document Solution ID: ER5CO
  • PubMed Identifier: 27519711
ISSN
0340-5761
Ausgabe der Veröffentlichung
4
Zeitschrift
ARCHIVES OF TOXICOLOGY
Schlüsselwörter
  • Adverse side effects
  • Asteraceae
  • Cancer
  • Chemotherapy
  • Traditional Chinese medicine
  • Toxicity
Paginierung
1833 - 1846
Datum der Veröffentlichung
2017
Status
Published
Titel
Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature
Sub types
  • Review
Ausgabe der Zeitschrift
91

Data source: Web of Science (Lite)

Other metadata sources:
Autoren
  • Thomas Efferth
  • Ursula Schöttler
  • Sanjeev Krishna
  • Peter Schmiedek
  • Frederik Wenz
  • Frank A Giordano
DOI
10.1007/s00204-016-1810-z
eISSN
1432-0738
ISSN
0340-5761
Ausgabe der Veröffentlichung
4
Zeitschrift
Archives of Toxicology
Sprache
en
Online publication date
2016
Paginierung
1833 - 1846
Datum der Veröffentlichung
2017
Status
Published
Herausgeber
Springer Science and Business Media LLC
Herausgeber URL
http://dx.doi.org/10.1007/s00204-016-1810-z
Datum der Datenerfassung
2022
Titel
Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature
Ausgabe der Zeitschrift
91

Data source: Crossref

Abstract
Glioblastoma multiforme (GBM) represents an aggressive tumor type with poor prognosis. The majority of GBM patients cannot be cured. There is high willingness among patients for the compassionate use of non-approved medications, which might occasionally lead to profound toxicity. A 65-year-old patient with glioblastoma multiforme (GBM) has been treated with radiochemotherapy including temozolomide (TMZ) after surgery. The treatment outcome was evaluated as stable disease with a tendency to slow tumor progression. In addition to standard medication (ondansetron, valproic acid, levetiracetam, lorazepam, clobazam), the patient took the antimalarial drug artesunate (ART) and a decoction of Chinese herbs (Coptis chinensis, Siegesbeckia orientalis, Artemisia scoparia, Dictamnus dasycarpus). In consequence, the clinical status deteriorated. Elevated liver enzymes were noted with peak values of 238 U/L (GPT/ALAT), 226 U/L (GOT/ASAT), and 347 U/L (γ-GT), respectively. After cessation of ART and Chinese herbs, the values returned back to normal and the patient felt well again. In the literature, hepatotoxicity is well documented for TMZ, but is very rare for ART. Among the Chinese herbs used, Dictamnus dasycarpus has been reported to induce liver injury. Additional medication included valproic acid and levetiracetam, which are also reported to exert hepatotoxicity. While all drugs alone may bear a minor risk for hepatotoxicity, the combination treatment might have caused increased liver enzyme activities. It can be speculated that the combination of these drugs caused liver injury. We conclude that the compassionate use of ART and Chinese herbs is not recommended during standard radiochemotherapy with TMZ for GBM.
Addresses
  • Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Staudinger Weg 5, 55128, Mainz, Germany. efferth@uni-mainz.de.
Autoren
  • Thomas Efferth
  • Thomas Efferth
  • Ursula Schöttler
  • Sanjeev Krishna
  • Peter Schmiedek
  • Frederik Wenz
  • Frank A Giordano
DOI
10.1007/s00204-016-1810-z
eISSN
1432-0738
Externe Identifier
  • PubMed Identifier: 27519711
Open access
false
ISSN
0340-5761
Ausgabe der Veröffentlichung
4
Zeitschrift
Archives of toxicology
Schlüsselwörter
  • Humans
  • Glioblastoma
  • Artemisinins
  • Dacarbazine
  • Drugs, Chinese Herbal
  • Antineoplastic Combined Chemotherapy Protocols
  • Aged
  • Female
  • Chemoradiotherapy
  • Chemical and Drug Induced Liver Injury
  • Temozolomide
  • Artesunate
Sprache
eng
Medium
Print-Electronic
Online publication date
2016
Paginierung
1833 - 1846
Datum der Veröffentlichung
2017
Status
Published
Datum der Datenerfassung
2016
Titel
Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature.
Sub types
  • Review
  • Journal Article
  • Case Reports
Ausgabe der Zeitschrift
91

Data source: Europe PubMed Central

Abstract
Glioblastoma multiforme (GBM) represents an aggressive tumor type with poor prognosis. The majority of GBM patients cannot be cured. There is high willingness among patients for the compassionate use of non-approved medications, which might occasionally lead to profound toxicity. A 65-year-old patient with glioblastoma multiforme (GBM) has been treated with radiochemotherapy including temozolomide (TMZ) after surgery. The treatment outcome was evaluated as stable disease with a tendency to slow tumor progression. In addition to standard medication (ondansetron, valproic acid, levetiracetam, lorazepam, clobazam), the patient took the antimalarial drug artesunate (ART) and a decoction of Chinese herbs (Coptis chinensis, Siegesbeckia orientalis, Artemisia scoparia, Dictamnus dasycarpus). In consequence, the clinical status deteriorated. Elevated liver enzymes were noted with peak values of 238 U/L (GPT/ALAT), 226 U/L (GOT/ASAT), and 347 U/L (γ-GT), respectively. After cessation of ART and Chinese herbs, the values returned back to normal and the patient felt well again. In the literature, hepatotoxicity is well documented for TMZ, but is very rare for ART. Among the Chinese herbs used, Dictamnus dasycarpus has been reported to induce liver injury. Additional medication included valproic acid and levetiracetam, which are also reported to exert hepatotoxicity. While all drugs alone may bear a minor risk for hepatotoxicity, the combination treatment might have caused increased liver enzyme activities. It can be speculated that the combination of these drugs caused liver injury. We conclude that the compassionate use of ART and Chinese herbs is not recommended during standard radiochemotherapy with TMZ for GBM.
Date of acceptance
2016
Autoren
  • Thomas Efferth
  • Ursula Schöttler
  • Sanjeev Krishna
  • Peter Schmiedek
  • Frederik Wenz
  • Frank A Giordano
Autoren-URL
https://www.ncbi.nlm.nih.gov/pubmed/27519711
DOI
10.1007/s00204-016-1810-z
eISSN
1432-0738
Ausgabe der Veröffentlichung
4
Zeitschrift
Arch Toxicol
Schlüsselwörter
  • Adverse side effects
  • Asteraceae
  • Cancer
  • Chemotherapy
  • Toxicity
  • Traditional Chinese medicine
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols
  • Artemisinins
  • Artesunate
  • Chemical and Drug Induced Liver Injury
  • Chemoradiotherapy
  • Dacarbazine
  • Drugs, Chinese Herbal
  • Female
  • Glioblastoma
  • Humans
  • Temozolomide
Sprache
eng
Country
Germany
Paginierung
1833 - 1846
PII
10.1007/s00204-016-1810-z
Datum der Veröffentlichung
2017
Status
Published
Datum, an dem der Datensatz öffentlich gemacht wurde
2017
Titel
Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature.
Sub types
  • Case Reports
  • Journal Article
  • Review
Ausgabe der Zeitschrift
91

Data source: PubMed

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