Tamoxifen-induced non-alcoholic steatohepatitis: where are we now and where are we going?

  title={Tamoxifen-induced non-alcoholic steatohepatitis: where are we now and where are we going?},
  author={Khalid A. Osman and Meissa M. Osman and Mohamed H. Ahmed},
  journal={Expert Opinion on Drug Safety},
  pages={1 - 4}
Tamoxifen is a cheap and effective estrogen-receptor antagonist, used as the adjuvant hormonal treatment of choice in women with estrogen-receptor-positive breast cancer. Tamoxifen-induced non-alcoholic steatohepatitis (NASH) may increase the demand on oncologists, not only with regard to screening for diabetes, but also for the suggested link of NASH with high incidence of coronary heart disease. At present, there is no guideline for treatment of hyperlipidaemia associated with tamoxifen… 

Incidence and risk factors for non-alcoholic steatohepatitis in females treated with tamoxifen for breast cancer.

The association of nonalcoholic steatohepatitis and tamoxifen in patients with breast cancer

Nonalcoholic steatohepatitis is a form of liver damage that can progress to cirrhosis that is associated with obesity and diabetes and may be associated with some medications, including tamoxifen.

Risk of fatty liver after long-term use of tamoxifen in patients with breast cancer

Tamoxifen had a significant effect on the fatty liver status compared to other treatment modalities in breast cancer patients and although fatty liver did not affect the prognosis of breast cancer, meticulous attention to cardiovascular disease or other metabolic disease should be paid when used for a long time.

Effects of Tamoxifen vs. Toremifene on fatty liver development and lipid profiles in breast Cancer

TAM treatment is significantly associated with more severe fatty liver disease and liver fibrosis, while TOR is associated with an overall improvement in lipid profiles, which supports continuous monitoring of liver imaging and serum lipid levels during SERM treatment.

A prospective, randomized study on hepatotoxicity of anastrozole compared with tamoxifen in women with breast cancer

Postmenopausal women with hormone receptor‐positive breast cancer receiving adjuvant anastrozole displayed less fatty liver disease, suggesting that this drug had a more favorable hepatic safety profile than tamoxifen and may be preferred for patients with potential hepatic dysfunction.

Fatty liver formation in patients with breast cancer on tamoxifen therapy in Iraqi female

This is a prospective, hospital based, case-control study conducted at Oncology and  Nuclear medicine specialist Hospital, in Nineveh province in Iraq during the period from February 2018 to November

ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury.

Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation.

Non-alcoholic fatty liver disease and diabetes: from physiopathological interplay to diagnosis and treatment.

The published data is sought to outline the published data including epidemiology, pathogenesis, diagnosis and treatment of NAFLD in diabetic patients, in order to better understand the interplay between these two prevalent diseases.



Tamoxifen-Induced Steatohepatitis

Liver function tests should be regularly done during tamoxifen treatment, and, in the case of prolonged and unexplained elevations of aminotransferase levels, liver biopsy must be done.

Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial

Tamoxifen was associated with higher risk of development of non-alcoholic steatohepatitis only in overweight and obese women with features of metabolic syndrome, but the disease after 10 years of follow up seems to be indolent.

CYP17 polymorphism and tamoxifen-induced hepatic steatosis.

Rosuvastatin: A safe and effective treatment for dyslipidaemia associated with non-alcoholic steatohepatitis (NASH)

  • M. H. Ahmed
  • Biology, Medicine
    Scandinavian journal of gastroenterology
  • 2006
Rosuvastatin as a potent lipid-lowering medication not metabolized through hepatic Cytochrome P450 may be an effective treatment for NASH dyslipidaemia.

Serum leptin levels are associated with tamoxifen -induced hepatic steatosis

Serum leptin levels were found to be significantly elevated in patients with increased hepatic steatosis after tamoxifen treatment, suggesting that the exact mechanism involved should be investigated in further studies.

Fatty liver and drugs.

Drug-induced liver diseases (DILD) are clinico-pathologic patterns of liver injury caused by drugs or other foreign compounds, and clinical DILD syndromes include acute viral hepatitis-like injury, acute liver failure, cholestatic hepatitis, liver disease with signs of hypersensitivity, autoimmune hepatitis- like injury and steatohepatitis.

Mitochondrial injury in steatohepatitis

Patients with non-alcoholic steatohepatitis have increased lipid peroxidation, increased tumour necrosis factor-α (TNF-α) and increased mitochondrial β-oxidation rates, which could lead to mitochondrial membrane permeability and apoptosis, and chronic apoptosis is compensated by increased cell proliferation, which, together with oxidative DNA damage, may cause gene mutations and cancer.

Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States

Individuals with elevated serum ALT activity in the absence of viral hepatitis or excessive alcohol consumption, most of whom have NAFLD, have an increased calculated risk of CHD, more prominent in women.

Non-alcoholic steatoheptatitis. In: Metabolic Syndrome

  • Byrne CD, Wild S (Eds),
  • 2005