Q&A: Vascular Complications Of Cytotoxics: Hepatic Veno-Occlusive Disease

Anticancer drugs have improved mortality rates and 5-year survival rates in patients with cancer, however, many of the modern chemotherapies are associated with cardiovascular toxicities that increase cardiovascular risk in cancer patients, including the development of hepatic veno-occlusive disease in certain cases.

In this article:
Hepatic veno-occlusive complication of cytotoxics
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Hepatic veno-occlusive complication of cytotoxics

Hepatic sinusoidal obstruction syndrome (SOS), also termed hepatic veno-occlusive disease (VOD), is characterized by hepatomegaly, right upper quadrant pain, jaundice, and ascites. It most often occur in patients undergoing hematopoietic cell transplantation (HCT) and less commonly following the use of certain chemotherapeutic agents in non-transplant settings, ingestion of alkaloid toxins, after high dose radiation therapy, or liver transplantation.

MCQ exam: clinical scenario

Vascular abnormalities are a known side effect of several cytotoxic drugs.

Which of the following cytotoxic drugs is most likely to lead to hepatic veno-occlusive disease?

a) Cyclophosphomide
b) 5-Fluorouracil
c) Taxoids
d) Cyclopentenyl cytosine
e) Trastuzumab

MCQ exam: answer

The correct answer is A.
Cyclophosphamide is the most likely to result in hepatic veno-occlusive disease (sinusoidal obstruction syndrome)

MCQ exam: explanation

Cyclophosphamide has been implicated in the development of hepatic veno-occlusive disease.

Other drugs and toxic alkaloids that have been implicated in the development of hepatic sinusoidal obstruction syndrome include busulfan, cytarabine, carmustine, mitomycin, 6-mercaptopurine, azathioprine, and dacarbazine.

Reference(s)
1). UpToDate: Diagnosis of hepatic sinusoidal obstruction syndrome (veno-occlusive disease) following hematopoietic cell transplantation. Available online: https://www.uptodate.com/contents/diagnosis-of-hepatic-sinusoidal-obstruction-syndrome-veno-occlusive-disease-following-hematopoietic-cell-transplantation