, Volume 58, Issue 5, pp 1415-1421
Date: 05 Dec 2012

Clinical and Histological Features of Idiosyncratic Acute Liver Injury Caused by Temozolomide

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Introduction

Temozolomide (Temodar, Merck) [1] is an orally or parenterally available alkylating drug indicated for the treatment of adult patients with primary brain tumor. Initially approved by the Food and Drug Administration (FDA) in 1999 for refractory anaplastic astrocytoma, it was subsequently approved for the primary treatment of glioblastoma multiforme with concomitant radiotherapy in 2005 [13]. Temozolomide is also used off-label for selected patients with metastatic melanoma with encouraging results [4, 5]. The oral or intravenous daily dose of temozolomide is 75–200 mg/m2 for varying duration depending on the clinical setting. The main dose limiting side effects are related to myelosuppression, with only a minority of patients experiencing reversible neutropenia, thrombocytopenia, and anemia that leads to early cessation of the drug. The most commonly reported non-hematologic adverse events are nausea, vomiting, headache, fatigue, and constipation that develop in 10 % or mo