Corticosteroid Therapy for Crizotinib-induced, Allergy-mediated Liver Injury: a Case Report

Background. Crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK-positive lung adenocarcinoma, has been shown to cause hepatic dysfunction; however, the appropriate treatment for crizotinib-induced hepatic injury has not yet been established. Case. We describe a case involving a 68-year-old woman with lung adenocarcinoma (cT4N3M1b, brain metastasis). After treatment for the brain metastasis, she was prescribed 500 mg/day of crizotinib. A drug eruption and elevation of the serum hepatic enzyme levels (aspartate transaminase [AST] 44 IU/l, alanine transaminase [ALT] 43 IU/l) and peripheral blood eosinophil ratio (7.0%) were noted on day 13 after beginning crizotinib treatment. On day 21, crizotinib was discontinued due to deterioration of the patient's hepatic function (AST 134 IU/l, ALT 207 IU/l). Four days later, she presented with a fever, worsening of the drug eruption and aggravation of the hepatic injury (AST 1823 IU/l, ALT 2756 IU/l), suggesting drug-induced, allergy-mediated liver injury. Subsequently, 250 mg/day of methylprednisolone was administered intravenously for three days, and her symptoms and the hepatic injury rapidly improved. Conclusions. Corticosteroids represent a promising treatment for crizotinib-related, allergy-mediated liver injury. Because crizotinib is a key drug for treating ALK-positive lung adenocarcinoma, further studies are needed to establish the most appropriate management strategy for crizotinib-induced liver injury.