title: Anticancer Dose Adjustment for Patients with Renal and Hepatic Dysfunction: From Scientific Evidence to Clinical Application.
abstract: Most anticancer agents exhibit a narrow therapeutic index, i.e., a small change in plasma concentrations can lead to a less efficacious treatment or an unacceptable degree of toxicity. This study aimed at providing health professionals with a feasible and time-saving tool to adapt the dose of anticancer agents for patients with renal or hepatic dysfunction. A guideline for anticancer agents was developed based on a literature search. An algorithm was generated to enhance the efficiency of the dose adaptation process. Finally, the dosing guideline was converted into an easy-to-use ExcelTMtool. The concept was applied to a total of 105 adult patients at the Centre for Integrated Oncology, Bonn, Germany. In total, 392 recommendations for dose adaptation were made and 320 (81.6%) recommendations were responded to by the oncologists. 98.4% of the recommendations were accepted. The algorithm simplifies the decision and screening process for high-risk patients. Moreover, it provides the possibility to quickly decide which laboratory tests are required and whether a dose adjustment for a particular anticancer drug is needed. The ExcelTMtool provides a recommended individual dose for patients with renal or hepatic dysfunction. The effectiveness of this strategy to reduce toxicity should be investigated in further studies before being adopted for routine use.
authors.affiliation: Institute of Pharmacy, Clinical Pharmacy, University of Bonn, D-53121 Bonn, Germany. tomi@fa.itb.ac.id.|School of Pharmacy, Institut Teknologi Bandung (ITB), Bandung 40132, Indonesia. tomi@fa.itb.ac.id.
authors.forename: Tomi
authors.initials: T
authors.lastname: Hendrayana
authors.affiliation: Institute of Pharmacy, Clinical Pharmacy, University of Bonn, D-53121 Bonn, Germany. a.wilmer@gmx.net.
authors.forename: André
authors.initials: A
authors.lastname: Wilmer
authors.affiliation: Institute of Pharmacy, Clinical Pharmacy, University of Bonn, D-53121 Bonn, Germany. v.kurth@uni-bonn.de.
authors.forename: Verena
authors.initials: V
authors.lastname: Kurth
authors.affiliation: Med. Klinik III und Poliklinik, Center for Integrated Oncology (CIO), University of Bonn, D-53127 Bonn, Germany. ingo.schmidt-wolf@ukb.uni-bonn.de.
authors.forename: Ingo Gh
authors.initials: IG
authors.lastname: Schmidt-Wolf
authors.affiliation: Institute of Pharmacy, Clinical Pharmacy, University of Bonn, D-53121 Bonn, Germany. u.jaehde@uni-bonn.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jaehde
keywords: anticancer; dose adjustment; hepatic dysfunction; renal dysfunction