For antiestrogens, please evaluate fatty liver first

In recent years,
More and more breast cancer patients
Anti-estrogen drugs should be taken after surgery.
Many patients are on medication
There were abnormalities in liver function,
In the course of outpatient consultation for liver disease
And I found out I got it.

Some patients with moderate to severe fatty liver disease
Abnormal liver function appears
And had to discontinue targeted therapy,
It leads to metastasis and recurrence of the tumor.

Take anti-estrogens
Why does it lead to fatty liver?
How to prevent and control?
An expert of gastroenterology from China Medical University
Answer for you!

Why does the anti-estrogen drug tamoxifen cause fat deposition in the liver?
It is now believed that tamoxifen can not only inhibit the expression of enzymes involved in the process of fatty acid oxidation, but also can competitively inhibit mitochondrial fatty acid oxidation by binding to target proteins, resulting in fatty acid accumulation and the development of fatty liver.
In addition, estrogen has a protective effect on fatty liver; antagonizing estrogen to reduce its level can lead to insulin resistance; tamoxifen can directly reduce the insulin sensitivity of liver cells and further induce insulin resistance, which is the most important pathogenic factor for the onset of non-alcoholic fatty liver disease (NAFLD).
The current study showed that the incidence of fatty liver disease in breast cancer patients treated with tamoxifen for 2 years was 43.2 %.
Therefore, the most recent oERall liver guidelines recommend that the metabolic syndrome component should be considered as a risk factor for drug-related fatty liver disease in patients treated with tamoxifen and associated with its severity, and that risk factors for fatty liver disease should be evaluated before taking the drug.

What should be evaluated before taking anti-estrogen drugs?
For these reasons, hepatologists recommend that risk factors for fatty liver disease be evaluated first before taking antiestrogens, including measurements of BMI, WHR, liver function, blood glucose, lipids, uric acid, HOMA, liver ultrasound, and liver fat content.
If there is more than moderate fatty liver with obvious inflammatory fibrosis patients, should be the first control of diet and weight, promote liver fat turnover to improve metabolic abnormalities.
According to the expert Consensus on prevention and Treatment of Liver Injury associated with Tumor Drugs in 2014, it is suggested that chemotherapy should be considered only when liver function meets the following standards and there is no liver underlying disease:
Serum bilirubin ≤ 1.5 × upper limit of normal value (N),
ALP, AST and ALT ≤ 2.5×N.
No metabolic risk factors or have get effective control, the liver fat content detection tip under moderate fatty liver, and close monitoring of liver function in the process of drug, blood glucose blood lipid blood insulin levels and liver fat content, in the early detection of liver lesions, early intervention, prevent the occurrence of end-stage liver disease, so as to improve the safety and efficacy of patients with breast cancer treatment.

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