Guidelines for Complications of Cancer Treatment Vol VIII Part B

Combination Chemotherapy:Combination chemotherapy uses several chemotherapeuticagents, each with a different mechanism of action and toxicityprofile. Along with the potential for greater tumor kill, however,the possibility for enhanced toxicity occurs.Adjuvant chemotherapy for breast cancer withcyclophosphamide, daunorubicin, and 5-FU has produced thatliver function abnormalities developed in 77% of patients (25).These abnormalities appeared within the first 3 months oftherapy and normalized in 90% of patients within a year ofcessation of treatment.General Guidelines for Chemotherapy DosageBased on hepatic Function (27)Drug Recommended Dose Reduction for HepaticDysfunction.Bleomycin : No dose reduction is necessary.Busulfan: No dose reduction is necessary.Carboplatin: No dose reduction is necessary.Chlorambucil : No dose reduction is necessary.Cisplatin: No dose reduction is necessary.Cyclophosphamide: Reduce by 25% if bilirubin 3.0–5.0 mg/dL or SGOT > 180 mg/dL. Omit if bilirubin > 5.0 mg/dL.Cytarabine : No formal recommendation for dose reduction.Dose reduction may be necessary in patients with hepaticdysfunction.Dacarbazine: No dose reduction is necessary.Dactinomycin: Reduce dose by 50% if bilirubin > 3.0 mg/dL.467