title: Risks and benefits of phase I liver dysfunction studies: should patients with severe liver dysfunction be included in these trials?
abstract: Introduction The goal of organ dysfunction Phase I trials is to characterize the safety and pharmacokinetics of novel agents in cancer patients with liver or kidney dysfunction, but the clinical benefit is not well established. Methods We reviewed 170 patients across 15 liver dysfunction studies at our institution, grouped based on the NCI-Organ Dysfunction Working Group criteria or Child-Pugh Score. Results The median survival for the entire cohort was two months and just one month amongst patients with severe liver dysfunction. Patients with normal or mild liver dysfunction, absence of tumor in liver, good performance status, higher serum albumin and lower bilirubin, aspartate transaminase and alkaline phosphatase had improved survival by univariate analysis. Serum albumin and liver function classification remained significant by multivariate analysis. Conclusion Given poor survival of patients with liver dysfunction, we need better criteria, such as albumin levels, for optimally selecting patients for liver dysfunction studies.
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.|Athens Naval and Veterans Hospital, 70 Dinokratous Str, 11521, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Fountzilas
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.|Laredo Hematology & Oncology Associates, 1710 E. Saunders, Tower A, 1st floor, Laredo, TX, 78041, USA.
authors.forename: Selena
authors.initials: S
authors.lastname: Stuart
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hernandez
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bowhay-Carnes
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Michalek
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: John
authors.initials: J
authors.lastname: Sarantopoulos
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Karnad
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Sukeshi
authors.initials: S
authors.lastname: Patel
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Weitman
authors.affiliation: University of Texas Health Science Center San Antonio, 7979 Wurzbach Rd, MC8026, San Antonio, TX, 78229, USA. mahalingam@uthscsa.edu.
authors.forename: Devalingam
authors.initials: D
authors.lastname: Mahalingam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D017321:Clinical Trials, Phase I as Topic; D005260:Female; D006801:Humans; D008107:Liver Diseases; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D018579:Patient Selection; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Liver dysfunction; Phase I study; Prognostic model; Survival