The Washington Manual of Oncology, 3 Ed.

Appendix I—Dose Adjustments of Commonly Used Chemotherapy Agents in Hepatic Failure and Renal Failure

B. Peters

INTRODUCTION

The clinical decision to dose adjust chemotherapy is often based on multiple factors related to the patient. These factors include, but are not limited to, patient’s age, previous treatments, performance status, comorbitities, hematologic parameters, neurologic function, and compromised renal and/or hepatic function.

Renal excretion and biliary excretion represent common routes for the elimination of many frequently used chemotherapy drugs. If either of these routes of excretion becomes impaired, the risk of decreased clearance of certain chemotherapy drugs increases. This decreased clearance can manifest itself as increased toxicity to the patient or may worsen the impaired renal or hepatic function. Thus, in the presence of diminished renal or hepatic function, recommendations may exist to modify dosing of various chemotherapy drugs. While some recommendations are well established, others are not, and variations may be found throughout the published literature. Tables I-1 and I-2 are intended to serve as guidelines for employing dose modifications when renal or hepatic impairment exists in the patient undergoing chemotherapy. The recommendations listed are based on single-agent therapy and do not account for combination therapy. If the patient is receiving combination chemotherapy, the clinician should consider potential additive effects. Guidelines for dialyzing chemotherapy drugs or dosing during dialysis are not included in the tables. Clinical judgment and patient assessment along with recommended dose modifications should dictate the final decision for any dose modification. The tables do not provide a complete list of recommendations, and the reader is cautioned to always refer to the prescribing information for the respective drug before making any treatment or dosing adjustment decision.