Version June 2024
| Agent | Liver function | Percent dose reduction administered initially* |
| Acalabrutinib | Severe hepatic impairment | Avoid use |
| Alectinib | Severe hepatic impairment | Reduce initial starting dose |
| Axitinib | Refer to UpToDate text | |
| Binimetinib | Moderate or severe hepatic impairment | Reduce initial starting dose from 45 to 30 mg orally twice daily |
| Bosutinib | Reduced starting doses (200 mg daily) for mild, moderate, or severe hepatic impairment | |
| Brentuximab | Reduce starting dose for mild liver impairment; avoid use for moderate to severe hepatic impairment | |
| Brigatinib | Severe hepatic impairment | Reduce initial starting dose |
| Ceritinib | Severe hepatic impairment | Reduce initial starting dose |
| Crizotinib | Moderate to severe hepatic impairment (total serum bilirubin or AST >1.5 times the ULN) | Reduce initial starting dose |
| Enfortumab | Moderate or severe hepatic impairment | Avoid use |
| Erlotinib | Direct bilirubin 1 to 7 mg/dL or ALT ≥3 times the ULN | Start at 75 rather than 150 mg daily |
| Everolimus | Child-Pugh A | 25% dose reduction for patients treated for breast cancer, renal cell cancer, or pancreatic neuroendocrine tumor; for patients with subependymal giant cell tumor, refer to manufacturer's FDA-approved package insert |
| Child-Pugh B | 50% reduction for patients treated for breast cancer, renal cell cancer, or pancreatic neuroendocrine tumor; for patients with subependymal giant cell tumor, refer to manufacturer's FDA-approved package insert | |
| Child-Pugh C | If potential benefits outweigh risks, maximum daily dose of 2.5 mg recommended | |
| Ibrutinib | Child-Pugh A | 140 rather than 420 mg daily |
| Child-Pugh B or C | Avoid use | |
| Imatinib | Total bilirubin >3 to 10 times the ULN | 25% dose reduction¶ |
| Infigratinib | Mild or moderate hepatic impairment | Reduce initial starting dose |
| Lapatinib | Severe hepatic impairment (Child-Pugh C) | 1250 mg per day initial dose (in conjunction with capecitabine) reduced to 750 mg once daily; 1500 mg per day initial dose (in conjunction with letrozole) reduced to 1000 mg once daily |
| Larotrectinib | Moderate or severe hepatic impairment | Reduce starting dose by 50% |
| Lenvatinib | Severe hepatic impairment (Child-Pugh C) | Reduce initial dose from 24 to 12 mg once daily |
| Neratinib | Severe hepatic impairment (Child-Pugh C) | Reduce starting dose from 240 to 80 mg daily |
| Nilotinib | Mild to moderate impairment (Child-Pugh A/B) | 600 rather than 800 mg daily |
| Severe hepatic impairment (Child-Pugh C) | 400 mg daily | |
| Pazopanib | Total bilirubin ≥1.5 times the ULN and/or ALT ≥2 times the ULN | Reduce to 200 mg daily |
| Pemigatinib | Severe hepatic impairment (total bilirubin >3 times the ULN) | Reduce initial starting dose |
| Ponatinib | Moderate to severe hepatic impairment (Child-Pugh B/C) | Avoid use |
| Regorafenib | Child-Pugh C disease | Avoid use |
| Ribociclib | Moderate to severe hepatic impairment (Child-Pugh B/C) | Reduce starting dose from 600 to 400 mg daily |
| Ruxolitinib | Refer to UpToDate text | Recommendations for dose modification vary according to indications for use. |
| Selpercatinib | Total bilirubin >3 to 10 times the ULN, and any AST elevation | Reduce initial dose to 80 mg orally twice daily |
| Sunitinib | Refer to UpToDate text | |
| Temsirolimus | Total bilirubin >1 to 1.5 times the ULN or AST greater than the ULN | Reduce dose to 15 mg per week |
| Total bilirubin >1.5 times the ULN | Avoid use | |
| Tucatinib | Severe hepatic impairment (Child-Pugh C) | Reduced initial dose |
| Zanubrutinib | Severe hepatic impairment (Child-Pugh C) | Reduced initial dose |
AST: aspartate aminotransferase; ULN: upper limit of normal; ALT: alanine aminotransferase; FDA: US Food and Drug Administration.
* Subsequent doses may be escalated as tolerated.
¶ Others[1] suggest the need to limit the total daily dose to 500 mg even in the setting of mild liver impairment (bilirubin <1.5 times the ULN).آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
