Commentary: Oncologic Drugs in Patients with Organ Dysfunction: A Summary

Abstract

After completing this course, the reader will be able to:1. Describe the currently recommended dose adjustments for common chemotherapeutics in oncology patients with organ dysfunction.2. Explain the rationale for using phase I dose-escalation studies to determine appropriate chemotherapy dosing in patients with organ dysfunction.3. Discuss the limitations of the currently available studies to guide chemotherapy dose adjustment in patients with organ dysfunction.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThere are few prospective data regarding the pharmacokinetics and clinical toxicity of commonly used chemotherapeutics in cancer patients with organ dysfunction. Although increasing numbers of studies are investigating newer chemotherapeutics in patients with liver or kidney dysfunction, most guidelines for dosing, especially for established agents, remain empiric. This review describes the available data (both prospective and case study) evaluating the impact of renal and hepatic dysfunction on toxicity and dosing of commonly used chemotherapeutics and provides a practical summary for their use in this setting.

Medical anticancer treatment of lung cancer associated with comorbidities: A review

“…For CDC, "persons receiving cytotoxic or immunosuppressive therapy (e.g., chemotherapy for malignant diseases, immunosuppression related to organ transplantation, and immunosuppression for rheumatologic and gastroenterologic Table 3 Anticancer drug treatment adaptation in the patient treated by haemodialysis, adapted from [36][37][38][39][40]46,47,82]. Anticancer drug dose adaptation to liver dysfunction (adapted from [57,58] disorders) should be tested for serologic markers of HBV infection (i.e., HBs Ag, anti-HBc, and anti-HBs)". For EASL, "all candidates for chemotherapy and immunosuppressive therapy should be screened for HBs Ag and anti-HBc prior to initiation of treatment".…”

“…Some reviews are available [57,58] and have been the sources of Table 4 that we have adapted for the purpose of the present review. None of those reviews refer to the cause of the hepatic dysfunction.…”

Suppression of hepatic tumor growth and metastasis by metronomic therapy in a rat model of hepatocellular carcinoma

“…In this clinical context, metronomic dosing of chemotherapeutic agents is expected to be a promising option in the future management of HCC. However, the optimal biologic dosing and scheduling still remain to be determined in the presence of underlying liver cirrhosis, because the metabolism and activation of chemotherapeutic drugs can be potentially affected by liver function (Superfin et al, 2007).…”

Management of hematological malignancies in patients affected by renal failure

“…Among antimetabolites, cytarabine [53,54,58,59], fludarabine [53][54][55]60,61,201,202], clofarabine [62], methotrexate (MTX) [26,[53][54][55]201], hydroxyurea [53], cladribrine [54,63] and pentostatin [64] require special precaution when administered in patients with RI; although potentially nephrotoxic (Table 2), no dose adjustment is recommended for the administration of azacitidine [65,66]. Cytarabine has a short halflife (15 min); its main indication is represented by AML [53,58,59].…”

“…Therefore, several degrees of RI may be diagnosed in a significant number of patients with HM at the disease onset. However, very few data on the incidence of RI in HM patients and on the pharmacological behavior of chemotherapeutic agents in this setting are available owing to the exclusion of neoplastic patients with any significant degree of renal dysfunction from Review Niscola, Vischini, Tendas et al most clinical trials [26,27]. Moreover, dose reduction is often based on limited data and empiric criteria.…”