Severe prolonged cholestatic hepatitis caused by exemestane

Abstract

Aromatase inhibitors (AIs) are used as first-line adjuvant hormonal therapy in postmenopausal women with hormone receptor-positive breast cancer, either as monotherapy or sequential therapy after tamoxifen. Unlike tamoxifen, the former gold standard adjuvant hormonal therapy, AIs cause musculoskeletal symptoms, osteoporosis, and bone fractures. Although AIs such as letrozole and anastrozole also cause liver enzyme elevation unrelated to liver metastasis in 35% patients,1,2 severe hepatotoxicity has rarely been associated with AIs. We report a case of severe prolonged cholestatic hepatitis caused by exemestane.