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Chemotherapy hepatotoxicity and dose modification in patients with liver disease

Topic Outline



Patients undergoing cytotoxic chemotherapy require careful assessment of liver function both prior to and during therapy. Potential interactions between the liver and chemotherapy fall into two categories:

Direct chemotherapy-induced hepatotoxicity.

Potentiation of preexisting liver disease, especially viral hepatitis. Altered hepatic drug metabolism due to underlying liver disease can result in higher or more persistent drug levels, thereby causing increased systemic toxicity (particularly myelosuppression) or worsening of liver function because of chemotherapy-induced hepatotoxicity.

The interrelationship between the liver and chemotherapy is reviewed here. General aspects of drug metabolism and patterns of hepatic injury are discussed separately as is reactivation of hepatitis B viral infection in patients treated with immunosuppressive therapy. (See "Drugs and the liver: Metabolism and mechanisms of injury" and "Drug-induced liver injury" and "Hepatitis B virus reactivation associated with immunosuppression".)


Mechanisms — Most hepatotoxic drug reactions are idiosyncratic and classified mechanistically either as immunologic (hypersensitivity) or metabolic [1]. These reactions typically are neither dose-dependent nor predictable. (See "Drugs and the liver: Metabolism and mechanisms of injury", section on 'Mechanisms of drug-induced hepatotoxicity'.)


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Literature review current through: Jun 2014. | This topic last updated: Jul 11, 2014.
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