Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Algorithm Development
2.3. Excel Tool
2.4. Guideline Application
3. Results
3.1. Development of the Dose Adaption Guideline
3.2. Algorithm Development
3.3. Excel Tool
3.4. Guideline Application and Acceptance
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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No. | Agent | Dose Adjustment in | Ref. | |
---|---|---|---|---|
Renal Dysfunction | Hepatic Dysfunction | |||
1. | Bendamustine |
| Moderate (transaminase 2.5–10 × ULN and T.Bil 1.5–3 × ULN) or severe (T.Bil > 3 × ULN), omit | [12] |
2. | Bleomycin |
| No adjustment is required | [9,13,14] |
3. | Capecitabine |
| No adjustment is required | [7,9,15,16] |
4. | Carboplatin | Dose based on GFR, using Calvert formula: Dose (mg) = target AUC × (GFR + 25). AUC = 5–7 For ESRD patient,
| No adjustment is required | [8,17,18,19] |
5. | Carmustine |
| Dosage adjustment maybe necessary; no specific recommendations found | [20,21] |
6. | Cisplatin |
| No adjustment is required | [7,8,22] |
7. | Cladribine |
| No specific recommendations found | [8,23] |
8. | Cyclophosphamide |
|
| [7] |
9. | Cytarabine |
| No specific recommendations found. Patient with liver dysfunction receiving cytarabine should be carefully monitored and adjust the dose based on clinical judgment. | [7] |
10. | Dacarbazine |
| No specific recommendations found. Patient with liver dysfunction receiving dacarbazine should be carefully monitored and adjust the dose based on clinical judgment. | [7] |
11. | Daunorubicin | Serum creatinine > 3 mg/dL, 50% of full dose |
| [7] |
12. | Docetaxel | No adjustment is required |
| [8,9,24,25] |
13. | Doxorubicin |
|
| [7,9] |
14. | Doxorubicin (Liposomal) | No adjustment is required |
| [7,26] |
15. | Epirubicin | Serum creatinine > 5 mg/dL, lower doses should be considered |
| [7,9] |
16. | Erlotinib | CrCl < 10 mL/min, omit |
| [27,28] |
17. | Etoposide |
|
| [7,8,9,29] |
18. | Fludarabine |
| No adjustment is required | [8,30] |
19. | Fluorouracil | No adjustment is required |
| [7,31] |
20. | Gemcitabine | No specific recommendations found |
| [9,27,32] |
21. | Hydroxyurea/Hydroxycarbamide |
|
| [7] |
22. | Idarubicin |
|
| [7,33] |
23. | Ifosfamide |
| No specific recommendations found | [7,9] |
24. | Imatinib |
|
| [34] |
25. | Irinotecan (Weekly, usual dose 125 mg/m2 for 4 of 6 weeks) | No adjustment anticipated to be required |
| [27,35] |
26. | Irinotecan (3 weekly, usual dose 350 mg/m2 every 3 weeks) | No adjustment anticipated to be required |
| [27,35,36] |
27. | Ixabepilone (monotherapy) | No specific recommendations found |
| [37] |
28. | Ixabepilone (in combination with capecitabine) | No specific recommendations found |
| [37] |
29. | Lenalidomide (use for myelodysplastic syndrome/MDS) |
| No specific recommendations found | [38,39] |
30. | Lenalidomide (use for Multiple Myeloma/MM) |
| No specific recommendations found | [38,39] |
31. | Lomustine |
| No specific recommendations found | [8,40] |
32. | Melphalan |
| No adjustment is required | [7,40,41] |
33. | Methotrexate | For low dose (<1 g/m2):
|
| [7,8] |
34. | Mitomycin C |
|
| [7] |
35. | Mitoxantrone | No adjustment is required |
| [7,42] |
36. | Oxaliplatin | CrCl < 30 mL/min, omit | No adjustment is required | [9,15,27,43] |
37. | Paclitaxel (3-h infusion and first course of therapy) | No adjustment is required |
| [44,45] |
38. | Paclitaxel (24-h infusion and first course of therapy) | No adjustment is required |
| [43,44] |
39. | Pemetrexed |
| No specific recommendations found | [21,46] |
40. | Pentostatin |
| Not applicable | [7] |
41. | Sorafenib | No adjustment is required |
| [27,47] |
42. | Topotecan |
| No adjustment is required | [7,9] |
43. | Vinblastine | No adjustment is required |
| [7,48] |
44. | Vincristine | No adjustment is required |
| [7,49] |
45. | Vinorelbine | No adjustment is required |
| [7,27,50,51] |
Characteristics | No. of Patients | Percentage |
---|---|---|
Sex | ||
Female | 37 | 35.2% |
Male | 68 | 64.8% |
Age, years | ||
Mean Age | 61.5 | |
Median Age | 66 | |
Range | 22–90 | |
Group of age | ||
Adult | 48 | 45.7% |
Elderly (≥65 years) | 57 | 54.3% |
Site of cancer prevalence | ||
Billiary tract | 7 | 6.7% |
Breast | 4 | 3.8% |
Colorectal | 23 | 21.9% |
Esophageal | 6 | 5.7% |
Gastric | 10 | 9.5% |
Lymphoma | 16 | 15.2% |
Myeloma | 4 | 3.8% |
Pancreatic | 13 | 12.4% |
Testicular | 6 | 5.7% |
Urethra | 6 | 5.7% |
Others * | 10 | 9.5% |
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Hendrayana, T.; Wilmer, A.; Kurth, V.; Schmidt-Wolf, I.G.; Jaehde, U. Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application. Sci. Pharm. 2017, 85, 8. https://doi.org/10.3390/scipharm85010008
Hendrayana T, Wilmer A, Kurth V, Schmidt-Wolf IG, Jaehde U. Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application. Scientia Pharmaceutica. 2017; 85(1):8. https://doi.org/10.3390/scipharm85010008
Chicago/Turabian StyleHendrayana, Tomi, André Wilmer, Verena Kurth, Ingo GH Schmidt-Wolf, and Ulrich Jaehde. 2017. "Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application" Scientia Pharmaceutica 85, no. 1: 8. https://doi.org/10.3390/scipharm85010008
APA StyleHendrayana, T., Wilmer, A., Kurth, V., Schmidt-Wolf, I. G., & Jaehde, U. (2017). Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application. Scientia Pharmaceutica, 85(1), 8. https://doi.org/10.3390/scipharm85010008