Liver atrophy and failure associated with paclitaxel and bevacizumab combination therapy for metastatic breast cancer

We managed 6 cases of severe liver atrophy and failure associated with paclitaxel and bevacizumab combination therapy (PB therapy) for HER2-negative metastatic breast cancer. In this case-control study, we examined the records of these 6 patients to investigate past treatment, medication history, and degree of atrophy, and compared their data with that of 67 patients without liver atrophy. The degree of the liver atrophy used SYNAPSE VINCENT® of the image analysis software. The results showed that patients with liver atrophy had a longer pretreatment period than those without liver atrophy (33.5 months vs 15.5 months), and they also experienced a longer median time to treatment failure with PB therapy than other patients (11 months vs 6 months). The ratio of individuals presenting with diffuse liver metastasis among patients with liver metastasis was 80% with liver atrophy, compared to 8% without liver atrophy. The degree of liver atrophy was an average of 67% in terms of volume ratio before/after PB therapy (57-82%). The individual with the greatest extent of liver atrophy died of liver failure, not as a result of breast cancer progression. The direct causal link between bevacizumab and liver atrophy and failure is unclear, but the individuals in this study had a long previous history of treatment, and diffuse liver metastases may develop in patients undergoing long periods of PB therapy, which may also cause liver atrophy; therefore, the possibility of liver failure should be considered in such cases.