Table 2.

Chemotherapy-associated acute steatohepatitis (CASH)—bullet points

Chemotherapeutics associated with CASH?	•Methotrexate, 5-fluoruracil, irinotecan, tamoxifen, L-asparaginase
Risk factors for developing CASH?	•Chronic liver disease, metabolic syndrome (obesity, diabetes mellitus, hyperlipidemia, arterial hypertension), genetic risk factors (polymorphism in PNPLA3 genotype)
Diagnostic work-up?	•Medical history •Standard laboratory analysis •Rule-in/-out previously undiagnosed chronic liver disease (CLD) if either (i) medical history or (ii) laboratory markers are indicative for chronic liver disease •If suspicious of CLD → perform diagnostic work-up including abdominal ultrasound, exclusion of other causes of CLD, non-invasive fibrosis scores •Discuss liver biopsy with your local hepatologist: risk/benefit •Discuss risk/benefits of chemotherapy with the patient •DO NOT delay initiation of chemotherapy longer than necessary
Monitoring during chemotherapy?	•Tight monitoring recommended in patients at high risk for CASH during chemotherapy

PNPLA3, Patatin-like phospholipase domain-containing protein 3.