Supplementary Material for: Drug-Induced Liver Injury in a Patient with Nonsmall Cell Lung Cancer after the Self-Administration of Fenbendazole Based on Social Media Information

Fenbendazole is a benzimidazole anthelmintic agent, with a broad antiparasitic range in animals such as dogs and pigs. The agent is also reported to exert antitumor effects and inhibit microtubule-associated tubulin polymerization, but its safety and tolerability profile in humans remains unclear. An 80-year-old female patient with advanced nonsmall cell lung cancer (NSCLC) was started on pembrolizumab monotherapy. The patient experienced severe liver injury 9 months later. An interview with her and her family revealed that she had been taking fenbendazole for a month, solely based on social media reports suggesting its effectiveness against cancer. After discontinuation of the self-administration of fenbendazole, the patient’s liver dysfunction spontaneously resolved. The antitumor inhibitory effects of fenbendazole have been reported; however, she did not experience tumor shrinkage. This is the first case report of a patient with advanced NSCLC who self-administered the anthelmintic, fenbendazole. Twitter and Facebook are online social media platforms which have been constructively used to exchange information among cancer patients. However, sources of medical information on these platforms are often unproven, and it is difficult for nonmedical professionals to accurately select and filter complex medical information. Physicians should enquire patients about self-administration of orally ingested products, including dietary supplements, herbs, or bioactive compounds, in cases of unexpected adverse reactions.

芬苯达唑（Fenbendazole）是一类苯并咪唑类抗蠕虫药（benzimidazole anthelmintic agent），对犬、猪等动物具有广谱抗寄生虫活性。现有研究显示该药物还具备抗肿瘤作用，可抑制微管相关微管蛋白的聚合，但其在人类中的安全性与耐受性特征仍未明确。

某80岁晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）女性患者接受帕博利珠单抗（pembrolizumab）单药治疗，治疗9个月后出现严重肝损伤。经对患者及其家属访谈核实，患者仅凭借社交媒体上关于芬苯达唑抗癌有效的相关报道，自行服用该药长达1个月。停用芬苯达唑后，患者的肝功能异常自行恢复。尽管已有文献报道芬苯达唑具有抗肿瘤抑制活性，但该患者并未出现肿瘤缩小的情况。本案例为首例晚期非小细胞肺癌患者自行服用抗蠕虫药芬苯达唑的病例报告。

推特（Twitter）与脸书（Facebook）作为在线社交媒体平台，已被癌症患者群体建设性地用于信息交流。然而，此类平台上的医疗信息来源通常未经证实，非医疗专业人员难以准确筛选、甄别复杂的医疗资讯。当患者出现不明原因的不良反应时，临床医师应主动询问患者是否自行服用过口服制剂，包括膳食补充剂、草本药物或生物活性化合物。