Hepatotoxicity induced by paclitaxel interaction with turmeric in association with a microcystin from a contaminated dietary supplement
The combination of paclitaxel (Taxol, Abraxane) and carboplatin (Paraplatin) have become major antineoplastic treatments for lung cancer over the past two decades. In the meantime, also the use of herbal remedies and/or dietary supplements during cancer treatment is growing among these patients many times contributing for fatal events.
A 67-year-old Caucasian male with lung cancer was presented to the Emergency Department with asthenia, anorexia, jaundice and choluria. The patient's lung cancer was being treated medically by a combination of paclitaxel/carboplatin with bi-monthly frequency. The patient was also self-medicating with several natural products, including Chlorella (520 mg/day), Silybum marianum (total of 13.5 mg silymarin/day), zinc sulphate (5.5 mg), selenium (50 μg) and 15 g/day of Curcuma longa. In first chemotherapy cycle no toxicity was observed even he was taking other medications as budesonide and sitagliptin. The toxic events started only after the introduction of the dietary products. Chlorella had contamination with cyanobacteria (Oscillatoriales) and 1.08 μg of cyanotoxin Microcystin-LR (MC-LR) per gram of biomass was found. Patient was consuming ca 0.01 μg MC-LR/kg/day. This case report describes the first known case of paclitaxel toxicity probably related to pharmacokinetic interaction with Turmeric and a contaminated Chlorella supplement resulting in an acute toxic hepatitis and the impact on oncologic patient health.