Liver cirrhosis following oxaliplatin-based adjuvant chemotherapy for rectal cancer

Abstract

Introduction: Oxaliplatin is a third-generation platinum-based antineoplastic drug that is widely used to treat patients with colorectal cancer. Reported adverse reactions include hepatic sinusoidal obstruction syndrome and liver fibrosis, but there are few reports of cirrhosis associated with chemotherapy. In addition, the pathogenesis of cirrhosis remains unclear.

Case report: We report a case of suspected oxaliplatin-induced liver cirrhosis, an adverse reaction that has not been previously reported.

Management and outcome: A 50-year-old Chinese man was diagnosed with rectal cancer and underwent laparoscopic radical rectal cancer surgery. The patient had a history of schistosomiasis, but history and serology showed no evidence of chronic liver disease. However, after five oxaliplatin-based chemotherapy cycles, the patient presented dramatic changes in liver morphology and developed splenomegaly, massive ascites, and elevated CA125 levels. Four months after discontinuing oxaliplatin, the patient's ascites had decreased significantly and CA125 levels declined from 505.3 to 124.6 mU/mL. After 15 weeks of follow-up, CA125 levels decreased to the normal range, and there has been no increase in ascites in this patient.

Discussion: Oxaliplatin-induced cirrhosis may be a serious complication and should be discontinued based on clinical evidence.

Keywords: Liver cirrhosis; oxaliplatin; rectal cancer; sinusoidal obstruction syndrome; splenomegaly.