Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2016; 22(15): 4062-4065
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.4062
Atypical onset of bicalutamide-induced liver injury
Gee Young Yun, Seok Hyun Kim, Seok Won Kim, Jong Seok Joo, Ju Seok Kim, Eaum Seok Lee, Byung Seok Lee, Sun Hyoung Kang, Hee Seok Moon, Jae Kyu Sung, Heon Young Lee, Kyung Hee Kim
Gee Young Yun, Seok Hyun Kim, Seok Won Kim, Jong Seok Joo, Ju Seok Kim, Eaum Seok Lee, Byung Seok Lee, Sun Hyoung Kang, Hee Seok Moon, Jae Kyu Sung, Heon Young Lee, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 301-721, South Korea
Kyung Hee Kim, Departments of Pathology, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 301-721, South Korea
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Supported by Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, South Korea.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Chungnam National University School of Medicine in Daejeon.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seok Hyun Kim, MD, PhD, Professor, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 266 Munhwa-ro, Daejeon 301-721, South Korea. midoctor@cnu.ac.kr
Telephone: +82-42-2807143 Fax: +82-42-2575753
Received: October 15, 2015
Peer-review started: October 16, 2015
First decision: November 5, 2015
Revised: November 30, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: April 21, 2016
Abstract

Anti-androgen therapy is the leading treatment for advanced prostate cancer and is commonly used for neoadjuvant or adjuvant treatment. Bicalutamide is a non-steroidal anti-androgen, used during the initiation of androgen deprivation therapy along with a luteinizing hormone-releasing hormone agonist to reduce the symptoms of tumor-related flares in patients with advanced prostate cancer. As side effects, bicalutamide can cause fatigue, gynecomastia, and decreased libido through competitive androgen receptor blockade. Additionally, although not as common, drug-induced liver injury has also been reported. Herein, we report a case of hepatotoxicity secondary to bicalutamide use. Typically, bicalutamide-induced hepatotoxicity develops after a few days; however, in this case, hepatic injury occurred 5 mo after treatment initiation. Based on this rare case of delayed liver injury, we recommend careful monitoring of liver function throughout bicalutamide treatment for prostate cancer.

Keywords: Bicalutamide, Drug-induced liver injury, Prostate neoplasm

Core tip: This case report describes a 62-year-old man with prostate cancer who experienced delayed liver injury after bicalutamide therapy. In previous case reports on bicalutamide-induced liver injury, liver failure occurred shortly after bicalutamide therapy initiation. However, in this case, liver injury occurred 5 mo after bicalutamide treatment initiation. Therefore, our case emphasizes that liver function measurements should be monitored from baseline for at least the first 6 mo of therapy, and then periodically during the entire period of treatment with bicalutamide.