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Tarceva-Induced Hepatotoxicity


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IMO long term use of Tarceva will result in some degree of hepatoxicity. My wife's liver function levels began slowly deteriorating about 60 ~ 90 days after starting treatment ( 3/3/05 ). For instance, her total bilirubin level has now tripled since 3/3/05 ( 0.4 to 1.2 mg/dL. ) and her albumin level has dropped and stayed below the reference range for several months now. Her AST and ALT have not been affected and have remained within the reference range. Some other reported total bilirubin levels that I'm aware of are much higher than my wife's. If your med onc hasn't already done so, I would urge any patient taking Tarceva for an extended period of time to request that your hematology panel include at least the basic liver function measures. Your basic CBC does not contain the information necessary to adequately evaluate liver function.


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I think most medications have some sort of adverse risks but they are usually fairly rare.

Tarceva may cause liver problems according to this:

http://www.tarceva.com/tarceva/professi ... safety.jsp

Other problem it can cause is Interstitial Lung Disease.

One thing to be aware of certain foods may cause an increase in the level of Tarceva in the body.

Fay A wrote about this awhile ago. one food to avoid is grapefruit and some other things like St John's Wort. So you might want to ask your Dr. I think the enzyme was CYP3A

http://www.tarceva.com/tarceva/pancreat ... o_take.jsp

http://depts.washington.edu/nwst/articl ... ctions.pdf

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P.S. Based on my wife's hematological history with Tarceva, plus collateral information, total bilirubin elevation and albumin decline seem to be the two key liver function measures to watch in connection with Tarceva-induced hepatotoxicity. AST and ALT elevations are also mentioned in the medical literature but, as I stated in my previous post, these levels have remained essentially unchanged in my wife's case. ALP elevation is also mentioned in the literature but since my wife has or had bone mets ( and consequential bone damage ) I don't place much weight on this measure when I review her liver function levels. The manufacturer summarizes it this way :


Asymptomatic increases in liver transaminases have been observed in TARCEVA treated patients; therefore, periodic liver function testing (transaminases, bilirubin, and alkaline phosphatase) should be considered. Dose reduction or interruption of TARCEVA should be considered if changes in liver function are severe (see ADVERSE REACTIONS section).


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