Abstract

Background: Out of approximately 1,6 million children in Sweden, about 350 are diagnosed with cancer each year. Chemotherapeutic agents are commonly used in the treatment of various cancer types in pediatric oncology. While it is established that certain chemotherapeutic agents induce hepatotoxicity as a side effect, a comprehensive assessment of the prevalence of hepatotoxicity in pediatric oncology populations has been lacking.

Aim: This study aims to investigate the prevalence of hepatotoxicity in pediatric patients between 0-18 years with intracranial and extracranial solid tumors. 

Method: A retrospective cohort study was conducted, at Uppsala University Children’s Hospital. Data regarding administered chemotherapeutic treatment and liver values such as alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (ALP), bilirubin and lactate dehydrogenase (LD), were collected over a 4-month period from start of treatment. Tto identify the treatment cycle in which hepatotoxicity occurred the data were divided into treatment cycles. During each treatment cycle, the liver values were collected on day 1, 8, 15, 22 or adjacent days. For patients experiencing hepatotoxicity, it was graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5. 

Results: Fifty patients were included, and the study yielded four main findings: 1) Approximately 30% of pediatric oncology patients experienced hepatotoxicity, 2) Treatment adjustments were implemented, such as dose reduction and treatment pause, for those with grade 3 and 4 toxicity, 3) Hepatotoxicity tends to exhibit a higher prevalence in males, 4) Hepatotoxicity tends to exhibit a higher prevalence in younger children. 

Conclusion: The observed prevalence of hepatotoxicity exceeded initial expectations, with approximately 30% suffer from hepatotoxicity due to chemotherapeutic treatment. However, future studies with larger sample size are needed.