Chemotherapy-Associated Steatohepatitis (CASH)

Agents associated with CASH:

(1) irinotecan

(2) oxaplatin

(3) temozolomide and dexamethasone

Features:

(1) appearance or worsening of fatty infiltration in the liver

(2) steatohepatitis on biopsy

(3) exclusion of other causes

Steatohepatitis can occur from several causes, the most common being alcohol and the obesity with the metabolic syndrome. A patient with cancer may have one or more causes for steatohepatitis other than the chemotherapy. The only way to be sure that steatohepatitis is chemotherapy-related or not is to exclude steatosis prior to starting chemotherapy.