Guidelines for Complications of Cancer Treatment Vol VIII Part B

delays excretion and eventually results in increasedaccumulation in plasma and tissues. Reducing the amount ofdoxorubicin administered decreases the values similar to thoseof patients with normal liver function who are receiving higherdoses.For bleomycin most human studies have found a very lowincidence of liver dysfunction; a review of more than 1,000patients who were treated with bleomycin concluded thathepatic toxicity was not consistently reported, and it couldnot be specifically ascribed to bleomycin (15).Microtubule Targeting Drugs: Vinca Alkaloidsvincristine is excreted primarily by the liver but has seldombeen implicated as a hepatotoxin. It has producedhepatotoxicity when used in combination with radiation.Vincristine and vinblastine are excreted primarily by the liverinto the bile.Taxanes:Paclitaxel and docetaxel are members of spindle inhibitors.Both are extensively excreted by the liver. AST Levels thatwere more than twice normal and bilirubins of 1.5 mg per dL,dose of paclitaxel should be less than 135 mg per m 2 , thosewith bilirubins of 1.6 to 3.0 mg per dL dose of paclitaxel is 75mg per m 2 or less, and those with bilirubins above 3 mg perdL dose of paclitaxel is 50 mg per m 2 (16).Topoisomerase II InhibitorsEtoposide is excreted primarily in the bile but is not usuallyconsidered hepatotoxic at standard doses (17) . At high doses,etoposide causes hyperbilirubinemia, elevatedaminotransferases, and elevated alkaline phosphatase activityapproximately 3 weeks after administration (18).465