Ascites Presenting as a Peritonitis‐Like Manifestation and Liver Injury due to Trabectedin Monotherapy in a Patient With Myxoid Liposarcoma
- 1Department of General Internal Medicine 4 Kawasaki Medical School Okayama Japan
- 2Department of Pathology Kawasaki Medical School Okayama Japan
Abstract
Background: Trabectedin is a synthetic, marine‐derived antitumor agent that exerts cytotoxic effects by binding to the minor groove of DNA. While trabectedin has demonstrated efficacy in advanced soft tissue sarcomas, hepatotoxicity and other adverse events remain concerns. However, cases involving drug‐induced liver injury with ascites are rare.
Case Presentation: We report a case of an 82‐year‐old woman with recurrent metastatic myxoid liposarcoma who developed simultaneous liver dysfunction and ascites after 12 cycles of trabectedin monotherapy. Laboratory tests revealed Grade 3 hepatic dysfunction, and imaging showed accumulation of ascitic fluid. In the absence of infection or thrombosis, a diagnosis of trabectedin‐induced liver injury with ascites was made. Supportive care, including hepatoprotective therapy, led to clinical improvement and resolution of the ascites.
Discussion: Hepatotoxicity is a recognized adverse effect of trabectedin, with proposed mechanisms including direct hepatocellular injury and cytokine‐mediated damage. Peritonitis‐like symptoms may arise from ascites secondary to hepatic dysfunction. In this case, hepatic dysfunction due to trabectedin may be the trigger for ascites presenting as a peritonitis‐like manifestation.
Conclusions: This case highlights the importance of vigilant monitoring during trabectedin therapy. Early recognition and management of liver injury and ascites presenting as a peritonitis‐like manifestation are crucial. Further research is warranted to elucidate the mechanisms and risk factors associated with these toxicities.
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BibTeX
@article{kawahara2026ascites,
title = {{Ascites Presenting as a Peritonitis‐Like Manifestation and Liver Injury due to Trabectedin Monotherapy in a Patient With Myxoid Liposarcoma}},
author = {Tatsuyuki Kawahara and Hiromichi Yamane and Ayaka Mimura and Hirohito Kirishi and Yusuke Sunada and Yoko Kosaka and Naruhiko Ichiyama and Yasunari Nagasaki and Nobuaki Ochi and Hidekazu Nakanishi and Hideyo Fujiwara and Nagio Takigawa},
journal = {Cancer reports (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1002/cnr2.70740},
url = {https://europepmc.org/article/PMC/PMC13722948},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ascites Presenting as a Peritonitis‐Like Manifestation and Liver Injury due to Trabectedin Monotherapy in a Patient With Myxoid Liposarcoma
AU - Tatsuyuki Kawahara
AU - Hiromichi Yamane
AU - Ayaka Mimura
AU - Hirohito Kirishi
AU - Yusuke Sunada
AU - Yoko Kosaka
AU - Naruhiko Ichiyama
AU - Yasunari Nagasaki
AU - Nobuaki Ochi
AU - Hidekazu Nakanishi
AU - Hideyo Fujiwara
AU - Nagio Takigawa
PY - 2026
DA - 2026/10/31
JO - Cancer reports (Hoboken, N.J.)
DO - 10.1002/cnr2.70740
UR - https://europepmc.org/article/PMC/PMC13722948
AB - Background: Trabectedin is a synthetic, marine‐derived antitumor agent that exerts cytotoxic effects by binding to the minor groove of DNA. While trabectedin has demonstrated efficacy in advanced soft tissue sarcomas, hepatotoxicity and other adverse events remain concerns. However, cases involving drug‐induced liver injury with ascites are rare. Case Presentation: We report a case of an 82‐year‐old woman with recurrent metastatic myxoid liposarcoma who developed simultaneous liver dysfunction and ascites after 12 cycles of trabectedin monotherapy. Laboratory tests revealed Grade 3 hepatic dysfunction, and imaging showed accumulation of ascitic fluid. In the absence of infection or thrombosis, a diagnosis of trabectedin‐induced liver injury with ascites was made. Supportive care, including hepatoprotective therapy, led to clinical improvement and resolution of the ascites. Discussion: Hepatotoxicity is a recognized adverse effect of trabectedin, with proposed mechanisms including direct hepatocellular injury and cytokine‐mediated damage. Peritonitis‐like symptoms may arise from ascites secondary to hepatic dysfunction. In this case, hepatic dysfunction due to trabectedin may be the trigger for ascites presenting as a peritonitis‐like manifestation. Conclusions: This case highlights the importance of vigilant monitoring during trabectedin therapy. Early recognition and management of liver injury and ascites presenting as a peritonitis‐like manifestation are crucial. Further research is warranted to elucidate the mechanisms and risk factors associated with these toxicities.
SN - 2573-8348
ER -