Carboplatin Treatment in Patients with Fatty Liver Disease

Introduction to Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of mildly elevated transaminases in asymptomatic patients, affecting 20-30% of the general population, according to the Mayo Clinic Proceedings and the Journal of the American College of Radiology 1, 2
Patients with NAFLD typically present with mildly elevated AST and/or ALT, with an AST:ALT ratio <1 in early disease, as reported by the Mayo Clinic Proceedings 1, 3
Bilirubin typically remains normal unless advanced disease is present, and normal bilirubin suggests compensated liver function, as stated by the Mayo Clinic Proceedings 1, 3
Elevated INR, hypoalbuminemia, or thrombocytopenia indicate cirrhosis or portal hypertension and represent advanced fibrosis, according to the Mayo Clinic Proceedings 1, 3

Before initiating carboplatin, evaluate the degree of transaminase elevation, with moderate-to-severe elevations (>5 times ULN) warranting further investigation before proceeding, as recommended by the Journal of the American College of Radiology 2
Evaluate for advanced liver disease/cirrhosis by checking albumin, INR, bilirubin, and platelet count, with normal values suggesting compensated disease without contraindication to carboplatin, as stated by the Mayo Clinic Proceedings 1, 3
Obtain baseline imaging if not already done, with ultrasound able to confirm steatosis and assess for cirrhosis, as reported by the Mayo Clinic Proceedings and the Journal of the American College of Radiology 1, 2

The American College of Radiology recommends caution when using carboplatin in patients with decompensated cirrhosis or synthetic dysfunction, and multidisciplinary discussion with oncology and hepatology is warranted 1
The Mayo Clinic Proceedings suggest that carboplatin should be used with extreme caution or avoided in patients with decompensated cirrhosis with ascites, encephalopathy, or variceal bleeding 1