tretinoin and Liver-Failure

Although all-trans retinoic acid (ATRA) is widely used in acute promyelocytic leukemia (APL), there is little data as to whether or not ATRA is useful for patients with liver and renal failure. A 63-year-old APL patient, complicated by Child-Pugh class A liver cirrhosis and chronic renal failure (creatinine 3.2 mg/dL), was successfully treated with 45 mg/m(2)/day of ATRA. With three courses of chemotherapy, complete remission has been maintained for four years in this patient. Serum trough and maximum ATRA concentration, and the area under the curve (AUC) were not elevated. These observations suggest that full-dose ATRA therapy might be safely applicable to such a complicated case with APL.

Topics: Antineoplastic Agents; Humans; Hypercalcemia; Kidney Failure, Chronic; Leukemia, Promyelocytic, Acute; Liver Cirrhosis; Liver Failure; Male; Middle Aged; Polycystic Kidney Diseases; Remission Induction; Tretinoin

Many patients with liver cirrhosis are in a state of protein and energy malnutrition and require careful nutritional support. Our research has revealed that approximately 30% of the patients have protein-energy malnutrition, 40% protein malnutrition, and 10% energy malnutrition; 20% are in a normal nutritional state. Supplementation with branched-chain amino acids alleviates chronic liver failure, improves the protein nutritional state, and subsequently prolongs survival. In contrast, therapeutic modalities for energy malnutrition have not yet been fully elucidated and await further studies. Improved survival of the cirrhotic patients essentially brings a higher incidence of hepatocellular carcinoma (HCC). A synthetic analogue of vitamin A (acyclic retinoid or 4,5-dehydrogeranyl geranoic acid) prevents at least the development of second primary tumors after curative treatment of preceding HCC. The mechanism of this cancer chemo-prevention is clonal deletion of premalignant and latent malignant cells by the retinoid. We describe our clinical experiences with these two nutritional pharmacotherapies of chronic liver diseases and review their basic mechanisms.

Topics: Amino Acids, Branched-Chain; Antineoplastic Agents; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Combined Modality Therapy; Humans; Liver Cirrhosis; Liver Failure; Liver Neoplasms; Nutritional Support; Protein-Energy Malnutrition; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome; Tretinoin