report tamoxifen-induced liver cirrhosis. It is easy to withdraw tamoxifen from breast-cancer patients with non-alcoholic steatohepatitis (NASH), but the benefits of 5-year adjuvant tamoxifen undoubtedly outweigh the risk of cirrhosis if we can prevent the progression of NASH. Coadministration of bezafibrate to patients with tamoxifen-induced NASH, might help them to tolerate adjuvant tamoxifen.

400 mg bezafibrate, a peroxisome proliferator-activated receptor α (PPARα) activator, was given with tamoxifen to two patients with tamoxifen-induced NASH (liver/spleen ratio of computed tomography values–0· 255 and–0· 317 Housfield units) or with toremifene in a patient with toremifene-induced NASH (liver/spleen ratio 0· 071). The liver/spleen ratio reached normal values (> 0· 90) in two patients and recovered by more than 0· 7 in the other patient within 10 months without any obvious changes in bodyweight. Liver biopsy revealed a substantial reduction in the numbers of fat droplets in the liver (figure).