Guidelines for Complications of Cancer Treatment Vol VIII Part B

Daunorubicin: Reduce dose by 25% if bilirubin 1.5–3.0 mg/dL. Reduce dose by 50% if bilirubin > 3.0 mg/dL. Omit ifbilirubin > 5.0 mg/dL.Docetaxel: Omit if bilirubin > 1.5 mg/dL, SGOT > 60 mg/dL,or alkaline phosphatase > 2.5 × upper limit of normal.Doxorubicin: Reduce dose by 50% if bilirubin 1.5–3.0 mg/dL. Reduce dose by 75% if bilirubin 3.1–5.0 mg/dL. Omit ifbilirubin > 5.0 mg/dL.Etoposide Reduce dose by 50% if bilirubin 1.5–3.0 mg/dL orSGOT 60–180 mg/dL. Omit if bilirubin > 3 mg/dL or SGOT> 180 mg/dL.Fludarabine: No dose reduction is necessary.5-Fluorouracil: Omit if bilirubin > 5.0 mg/dL.Ifosfamide: No dose reduction is necessary.Imatinib : Omit if bilirubin > 3 mg/dL or SGOT > 5 × ULN.Once bilirubin < 1.5 or SGOT < 2.5 × ULN, reduce dosefrom 400 mg to 300 mg or from 600 mg to 400 mg.Irinotecan : No formal recommendation for dose reduction inthe presence of hepatic dysfunction. Dose reduction may benecessary.Melphalan: No dose reduction is necessary.6-Mercaptopurine: No dose reduction is necessary.Methotrexate: Reduce dose by 25% if bilirubin 3.1–5.0 mg/dL or SGOT > 180 mg/dL. Omit if bilirubin > 5.0 mg/dL.Oxaliplatin: N/A.Paclitaxel: dose reduction if bilirubin 1.5–3.0 mg/dL or SGOT60–180 mg/dL. Omit if bilirubin > 5.0 mg/dL or SGOT > 180mg/dL.468