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World J Hepatol. Sep 27, 2023; 15(9): 1021-1032
Published online Sep 27, 2023. doi: 10.4254/wjh.v15.i9.1021
Toxicity of targeted anticancer treatments on the liver in myeloproliferative neoplasms
Shubhrat Purwar, Anam Fatima, Himashree Bhattacharyya, Lakshmi Venkata Simhachalam Kutikuppala, Matei-Alexandru Cozma, Bahadar Singh Srichawla, Leah Komer, Khulud Mahmood Nurani, Mihnea-Alexandru Găman
Shubhrat Purwar, Department of Internal Medicine, Grant Government Medical College, Mumbai 400008, Maharashtra, India
Anam Fatima, Department of Internal Medicine, Pandit Jawaharlal Nehru Memorial Medical College, Raipur 492001, Chhattisgarh, India
Himashree Bhattacharyya, Department of Community & Family Medicine, AIIMS Guwahati, Assam 781101, India
Lakshmi Venkata Simhachalam Kutikuppala, Department of General Surgery, Dr NTR University of Health Sciences, Vijayawada 521104, Andhra Pradesh, India
Matei-Alexandru Cozma, Mihnea-Alexandru Găman, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 050474, Romania
Matei-Alexandru Cozma, Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
Bahadar Singh Srichawla, Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
Leah Komer, Department of Psychiatry, University of Toronto, Toronto M5G 1V7, Ontario, Canada
Khulud Mahmood Nurani, Faculty of Health Sciences, University of Nairobi, Nairobi 30197-00100, Kenya
Mihnea-Alexandru Găman, Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania
Author contributions: Purwar S, Fatima A, Bhattacharyya H, Simhachalam Kutikuppala LV, Cozma MA and Gaman MA reviewed the literature and drafted the manuscript; Srichawla BS, Nurani KM and Komer L edited the manuscript; Cozma MA and Gaman MA provided overall intellectual input, reviewed the literature, and edited the final version of the manuscript; all authors approved the final version to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mihnea-Alexandru Găman, Doctor, MD, PhD, Doctor, Research Fellow, Researcher, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, Bucharest 050474, Romania. mihneagaman@yahoo.com
Received: May 28, 2023
Peer-review started: May 28, 2023
First decision: July 17, 2023
Revised: August 6, 2023
Accepted: August 18, 2023
Article in press: August 18, 2023
Published online: September 27, 2023
Abstract

The liver has a central role in metabolism, therefore, it is susceptible to harmful effects of ingested medications (drugs, herbs, and nutritional supplements). Drug-induced liver injury (DILI) comprises a range of unexpected reactions that occur after exposure to various classes of medication. Even though most cases consist of mild, temporary elevations in liver enzyme markers, DILI can also manifest as acute liver failure in some patients and can be associated with mortality. Herein, we briefly review available data on DILI induced by targeted anticancer agents in managing classical myeloproliferative neoplasms: Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, and myelofibrosis.

Keywords: Myeloproliferative neoplasms, Chronic myeloid leukemia, Myelofibrosis, Polycythemia vera, Essential thrombocythemia, Hepatotoxicity, Drug-induced liver injury

Core Tip: Drug-induced liver injury (DILI) comprises a range of unexpected reactions that occur after exposure to any type of medication. Patients diagnosed with classical myeloproliferative neoplasms (MPNs) (chronic myeloid leukemia, polycythemia vera, essential thrombocythemia or primary myelofibrosis) are often prescribed pharmacological agents that can lead to DILI. Herein, we examine the hepatotoxic potential of kinase inhibitors used in the treatment of classical MPNs with a focus on DILI diagnosis, management and prevention. In most cases, DILI can be successfully managed with dose interruptions or reductions and use of hepatoprotective agents, however, in some cases drug cessation may be warranted.