Life threatening hepatotoxicity induced by Nilotinib

• Published in: Journal of oncology pharmacy practice Vol. 29; no. 2; pp. 465 - 468
• Main Authors: Khelifa, Latifa, Ben Amor, Imen, Kassar, Olfa, Mdhaffer, Moez, Hdiji, Sondes, Elloumi, Moez
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-03-2023; Sage Publications Ltd
• Subjects: Antineoplastic Agents - adverse effects; Case reports; Chemical and Drug Induced Liver Injury - drug therapy; Chemical and Drug Induced Liver Injury - etiology; Chronic myeloid leukemia; Cytolysis; Female; Hepatotoxicity; Humans; Inhibitor drugs; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - diagnosis; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Medical prognosis; Middle Aged; Myeloid leukemia; Patients; Pharmacokinetics; Protein Kinase Inhibitors - adverse effects; Protein-tyrosine kinase; Prothrombin; Pyrimidines - adverse effects; Quality of Life; Targeted cancer therapy; Treatment Outcome; Nilotinib; case report; Ehronic myeloid leukemia; hepatotoxicity
• ISSN: 1078-1552; 1477-092X
• DOI: 10.1177/10781552221102588

Introduction
Tyrosine kinase inhibitor had changed the prognosis of chronic myeloid leukemia (CML) and the overall survival had reached 95%. Unfortunately, adverse events (AEs) remain an obstacle to following successful treatment in CML impairing the quality of life and sometimes endangering the lives of patients. To this end, we show this clinical case to discuss strategies to deal with rare AEs in a way to preserve the patient's life and to maintain not only a good response to treatment but also confidence and compliance of the patient.
Case report
We report the case of a 57-year-old woman diagnosed with CML at the chronic phase who developed rare life-threatening hepatotoxicity (major cytolysis and prothrombin time fall) secondary to Nilotinib used as second-line treatment. This complication settled despite an optimal molecular response.
Management and outcome
We discuss below the follow-up and management in our center and according to the literature with more sophisticated pharmacological methods.
Discussion
Although we used to monitor disease molecular response to treatment, we need solutions and manuscripts for monitoring drug dose parameters to avoid unusual dangerous effects risking the patient life. We conclude that monitoring the disease as well as the treatment pharmacokinetics is mandatory to better carry on CML patients.