BACKGROUND

Breast cancer metastasizing to the liver with presence of a parenchymatous icterus presents a therapeutic dilemma. Treatment-related toxicity can be unpredictable due to altered drug clearance, and bilirubin exceeding 5,0 mg/dl is generally considered an absolute contraindication for the administration of cytotoxic agents. The pharmacokinetics of capecitabine--an active oral 5-fluorouracil prodrug for the treatment of advanced breast cancer--are not affected in patients with mild to moderate hepatic dysfunction, but there are no data available for patients with severe hyperbilirubinemia.

METHODS

We herein report the case of a female patient with advanced breast cancer with predominant liver metastases and severe hyperbilirubinemia (12 mg/dl). The patient received oral capecitabine at a dose of 2,500 mg/m2/day in 2 divided doses for 2 weeks, followed by 1 week rest.

RESULTS

Several assessments of liver function parameters including serum bilirubin showed a decrease to normal values within 2.5 months. After 7 courses of treatment, a partial remission was confirmed by CT scan. Treatment with capecitabine was well tolerated with grade 2 hand-and-foot syndrome and mild nausea being the only side effects.

CONCLUSIONS

This case report suggests that capecitabine can be safely administered without dose adjustment in patients with extensive liver metastases and hepatic dysfunction.