Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.
Adult ; Aged ; Antibiotics, Antineoplastic/adverse effects/therapeutic use ; Antimetabolites, Antineoplastic/adverse effects/therapeutic use ; Antineoplastic Agents/*adverse effects/therapeutic use ; Antineoplastic Agents, Alkylating/adverse effects/therapeutic use ; Drug-Induced Liver Injury/etiology/radiography ; Enzyme Inhibitors/adverse effects/therapeutic use ; Fatty Liver/etiology/radiography ; Female ; Humans ; Immunotherapy ; Liver Cirrhosis/etiology/radiography ; Liver Diseases/etiology/*radiography ; Male ; Middle Aged ; Neoplasms/therapy ; Tomography, X-Ray Computed

OBJECTIVEKanchnar guggulu is a compound Ayurvedic formulation used in clinical practice for the treatment of benign and malignant tumors. The present study investigates its cytotoxic and antiproliferative activities.

METHODSThe hydro-alcoholic (50%) extract of kanchnar guggulu was prepared. Its antimitotic activity was assessed in an Allium cepa assay, while its antiproliferative effects were studied in a yeast proliferation model. Methotrexate was used as a standard anticancer agent.

RESULTSIn the Allium assay, all concentrations of the extract (1, 2 and 3 mg/mL) and methotrexate (0.02 mg/mL) significantly inhibited the division of A. cepa root cells, decreasing root growth and mitotic index compared to control; this effect was concentration-dependent for kanchnar guggulu extract. In the antiproliferative studies, treatment with the hydro-alcoholic extract of kanchnar guggulu (1, 5 and 10 mg/mL) and methotrexate (0.025, 0.05 and 0.1 mg/mL) resulted in marked reduction of dividing Saccharomyces cerevisiae cells and inhibition of cell viability compared to control. The cytotoxicity of the hydro-alcoholic extract of kanchnar guggulu, shown by its antimitotic and antiproliferative effects, may be due to the presence of flavonoids and phenolics.

CONCLUSIONKanchnar guggulu exhibited a cytotoxic effect by inhibiting cell division (antimitotic) and reducing cell proliferation. These results substantiate its potential for the treatment of cancer and support its traditional use in the treatment of cancer.