Hepatotoxicity from chemotherapy drugs
The liver is the main site of drug metabolism in the body. The clinical manifestations of liver damage caused by antineoplastic drugs vary widely, and the vast majority of patients do not experience any conscious discomfort. If clinical symptoms do occur, they can vary depending on the type and extent of liver injury. When hepatocellular injury is the main cause, the manifestation is similar to viral hepatitis, including loss of appetite, nausea, jaundice, etc. The liver may also be enlarged. In severe cases, severe hepatitis-like manifestations may occur, which is relatively rare. The predominantly bilious condition is called drug-related jaundice, which is often asymptomatic or only has elevated transaminases and jaundice.
Prevention and treatment:
- The physician will know the patient’s previous liver function status and the presence of active hepatitis.
- Patients’ liver function status will be tested by the physician during chemotherapy.
- Patients are also followed for liver function after chemotherapy.
- Patients with signs of liver function impairment will be treated with symptomatic liver protection.
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Nephrotoxicity from chemotherapy drugs
Clinical manifestations of chemotherapy drug nephrotoxicity include oliguria, anuria, and hematuria in the naked eye. It may also be accompanied by nausea and vomiting, and poor appetite. Less commonly, when there is massive destruction of tumor cells, tumor lysis syndrome may occur: hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, causing acute renal insufficiency.
The physician can treat symptomatically with adequate hydration, appropriate alkalinization and diuresis, and if necessary, hemodialysis. For some specific drugs: such as isocyclophosphamide (IFO), the physician can apply a special protective agent, sodium mesylate. The non-toxic product is excreted rapidly by the urine through the combination of sodium mesylate in the urine with acrolein, the toxic metabolite of IFO. During chemotherapy the physician will assess the patient’s renal function, and for patients with abnormal renal function, a less nephrotoxic agent can be selected and the patient’s renal function changes can be checked.