| ?Background and aim of the study? Breast cancer is one of the most common malignant tumors in women.The treatment of breast cancer includes surgical treatment,chemotherapy,radiotherapy,targeted therapy and endocrine therapy.In recent years,with the increasing status of endocrine therapy in breast cancer treatment,more concern has been given to its adverse reactions.Drug-induced liver injuries are common complications of endocrine therapy for breast cancer,the most common of which is drug-induced fatty liver,which is often ignored as well,leading to serious adverse consequences.Therefore,as we pay attention to the curative effect of endocrine therapy for breast cancer,we should not ignore the safety events which may result from the medical treatment.In doing so,the final prognosis of patients will be ensured.This article reports two patients with breast cancer who were treated with tamoxifen(Tamoxifen,TAM)adjuvant endocrine therapy,which resulted in diffuse severe fatty liver and different therapeutic outcomes.The literature in related fields was analyzed retrospectively.The two cases are meant to arouse the attention of medical workers to the common toxic and side effects of endocrine therapy for breast cancer,and to increase the understanding of the characteristics and management of such adverse events,thus increasing the safety of treatment.?Method? Collect the clinical data of two breast cancer patients with diffuse severe fatty liver caused by TAM adjuvant endocrine therapy in clinical diagnosis and treatment,and related literature in this field is reviewed,in which the characteristics,mechanism,diagnosis,prevention and treatment of fatty liver caused by endocrine therapy of breast cancer are discussed.The suggestions were put forward about preventing and treating the adverse events of liver injury caused by endocrine therapy of breast cancer and the reasonable selection of drugs for breast cancer treatment.?Results?The two patients were both unmenopausal women,aged between 41 and 45 years old.Case 1 developed severe hepatic fatty degeneration within the time of 2.7 months.Case 2 had transaminase 4 times higher than the normal value during TAM treatment.The liver injuries of the two patients were considered to be drug-induced fatty liver caused by TAM.In case 1,TAM was stopped immediately after early imaging detection,and the endocrine treatment regimen was changed while liver protective drugs were given.The severity of fatty liver in patients was partially reversed in a short period of time.In case 2,after the discovery of patients' progressive aggravation in fatty liver,patients' personal will to continue using the drug leads to further exacerbation of the disease.In combination with literature review and analysis,the occurrence of drug-induced fatty liver caused by TAM in these two patients was earlier and more serious than that reported in the literature,and it could not be completely consistent with the serological indexes.It is suggested that the liver function should be reviewed regularly during the use of TAM.Early imaging is also necessary;and serious consequences can be avoided by early detection and timely intervention.?Conclusions? Although drug-induced liver injury is one of the most common adverse reactions in endocrine adjuvant treatment of breast cancer,especially in TAM,severe diffuse fatty liver is not common in short term.Clinicians should pay attention to patients who take TAM for a long time,strengthening clinical monitoring.Not only the assessment of tumor load should be paid attention to,but also safety events need to be alerted.For drug-induced fatty liver caused by TAM,early detection,early diagnosis and timely intervention are the keys in improving prognosis and avoiding serious consequences.At the same time,for patients with high risk factors of fatty liver who need endocrine treatment,we can consider changing the relevant treatment strategy,so as to secure the safety of treatment. |
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