MSKCC guidelines for FUDR dose modification

			FUDR dose
AST
Reference value (ref)*	≤50 units/L	>50 units/L
Current value^¶	0 to <3 x ref	0 to <2 x ref	100%
	3 to <4 x ref	2 to <3 x ref	80%
	4 to <5 x ref	3 to <4 x ref	50%
	≥5 x ref	≥4 x ref	HOLD
If held, restart when:	<4 x ref	<3 x ref	50% of last dose given
Alkaline phosphatase
Reference value (ref)	≤90 units/L	>90 units/L
Current value	0 to <1.5 x ref	0 to <1.2 x ref	100%
	1.5 to <2 x ref	1.2 to <1.5 x ref	50%
	≥2 x ref	≥1.5 x ref	HOLD
If held, restart when:	<1.5 x ref	<1.2 x ref	25% of last dose given
Total bilirubin
Reference value (ref)	≤1.2 mg/dL	>1.2 mg/dL
Current value	0 to <1.5 x ref	0 to <1.2 x ref	100%
	1.5 to <2 x ref	1.2 to <1.5 x ref	50%
	≥2 x ref	≥1.5 x ref	HOLD
If held, restart when:	<1.5 x ref	<1.2 x ref	25% of last dose given

MSKCC: Memorial Sloan Kettering Cancer Center; FUDR: fluorodeoxyuridine; AST: aspartate aminotransaminase.
* Reference value is the value obtained on the day the patient received last FUDR dose.
¶ Current value is the value obtained at pump emptying or on the day of planned treatment (whichever is higher).

Adapted with permission from: Zalcberg JR, Kemeny NE. Systemic or regional chemotherapy for liver metastases from colorectal cancer: Has the wheel stopped spinning? Cancer J 2004; 10:271. Copyright © 2004 MediMedia.

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MSKCC guidelines for FUDR dose modification