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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Cytotoxic chemotherapy dose modification in patients with preexisting liver disease*

Cytotoxic chemotherapy dose modification in patients with preexisting liver disease*
Agent Bilirubin Aminotransferases Percent dose administered Reference
Bendamustine ≥1.5 × ULN ≥2.5 × ULN Not recommended  
Bortezomib >1.5 × ULN   Reduce starting dose to 0.7 mg/m2  
Cabazitaxel >ULN AST/ALT ≥1.5 × ULN 0%  
Carfilzomib     Refer to text  
Cyclophosphamide 3.1 to 5 mg/dL AST ≥180 IU/L 75% [1]
>5 mg/dL   0%
Cytarabine   Any 50%; subsequent increase by monitoring toxicity [1]
Dactinomycin   Any 50%; subsequent increase by monitoring toxicity  
Daunorubicin 1.2 to 3 mg/dL   75% [1]
3 to 5 mg/dL   50%
>5 mg/dL   0%
Docetaxel     Refer to text  
Doxorubicin 1.2 to 3 mg/dL ALT or AST >3 × ULN 50% [1]
3 to 5 mg/dL   25%
>5 mg/dL   0%
Epirubicin 1.2 to 3 mg/dL 2 to 4 × ULN 75% [1]
>3 mg/dL >4 × ULN 50%
Eribulin     Refer to text  
Etoposide 1.5 to 3 mg/dL AST >3 × ULN 50% [1]
Fluorouracil >5 mg/dL   0% [1]
Gemcitabine >1.6 mg/dL   80%  
Ifosfamide >3 mg/dL   25% [1,2]
Irinotecan 1.5 to 3 mg/dL   75% [1]
Ixabepilone monotherapy ≤1 × ULN AST and ALT ≤2.5 × ULN Initial dose (40 mg/m2)  
≤1 × ULN AST and ALT ≤10 × ULN Initial dose (32 mg/m2)
>1.5 to ≤3 × ULN AST and ALT ≤10 × ULN Initial dose (20 to 30 mg/m2)
>3 × ULN >10 × ULN Not recommended
Ixabepilone plus capecitabine ≥2.5 × ULN Above ULN Not recommended  
Ixazomib >1.5 × ULN   Reduce starting dose to 3 mg  
Paclitaxel     Refer to text  
Panobinostat ≥1 × ULN AST >1 × ULN 75%  
>1 to 1.5 × ULN Any 75%
>1.5 to 3 × ULN Any 50%
>3 × ULN   Not recommended
Pomalidomide     Refer to text  
Procarbazine >5 mg/dL ALT or AST >3 × ULN 0% [1]
Trabectedin     Refer to text  
Vincristine, vinblastine >3 mg/dL   50% [3]
Vinorelbine 2.1 to 3 mg/dL   50% [1]
>3 mg/dL   25%
Vorinostat >1 to 3 × ULN   Reduce initial doseΔ  
>3 × ULN   Not recommended
ULN: upper limit of normal; AST: aspartate aminotransferase; ALT: alanine aminotransferase; IU: international units.
* Not an inclusive list.
¶ Controversial. Supported by some studies[4], but not others[5].
Δ US Food and Drug Administration (FDA) guidelines; Canadian guidelines recommend avoiding the drug for total bilirubin ≥1.5 × ULN.
References:
  1. Floyd J, Mirza I, Sachs B, Perry MC. Hepatotoxicity of chemotherapy. Semin Oncol 2006; 33:50.
  2. Falkson G, Hunt M, Borden EC, et al. An extended phase II trial of ifosfamide plus mesna in malignant mesothelioma. Invest New Drugs 1992; 10:337.
  3. Desai ZR, Van den Berg HW, Bridges JM, Shanks RG. Can severe vincristine neurotoxicity be prevented? Cancer Chemother Pharmacol 1982; 8:211.
  4. Venook A, Egorin MJ, Rosner GL, et al. Phase I and pharmacokinetic trial of gemcitabine in patients with hepatic or renal dysfunction: Cancer and Leukemia Group B 9565. J Clin Oncol 2000; 18:2780.
  5. Teusink A, Hall PD. Toxicities of gemcitabine in patients with severe hepatic dysfunction. Ann Pharmacother 2010; 44:750.
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