SUPPORTIVE CARE OF CHILDREN WITH CANCER: PREVENTION AND TREATMENT OF CHEMOTHERAPY-INDUCED LIVER TOXICITY (SPECIFIC MODIFICATIONS OF CHEMOTHERAPEUTIC AGENTS WITH LIVER-DEPENDENT METABOLISM)
A. Vincristine, vinblastine, and VP-16 (etoposide)Bilirubin <1.5 mg/dL and aspartate aminotransferase (SGOT) <60 U/mL: give 100% dose.Bilirubin 1.5-3.0 mg/dL or SGOT 60-180 U/mL: give 50% dose.Bilirubin >3.1 mg/dL or SGOT >180 U/mL: hold dose.B. Adriamycin, daunorubicin, idarubicin, and actinomycin-DBilirubin <1.5 mg/dL and SGOT <60 U/mL: give 100% dose.Bilirubin 1.5-3.0 mg/dL or SGOT 60-180 U/mL: give 50% dose.Bilirubin 3.1-5.0 mg/dL or SGOT >180 U/mL: give 25% dose.Bilirubin >5.0 mg/dL: hold dose.C. Methotrexate and cyclophosphamideBilirubin <1.5 mg/dL and SGOT <60 U/mL: give 100% dose.Bilirubin 1.5-3.0 mg/dL or SGOT 60-180 U/mL: give 50% dose.Bilirubin 3.1-5.0 mg/dL or SGOT <180 U/mL: give 25% dose.Bilirubin >5.0 mg/dL: hold dose.Restart at 5096 dose when bilirubin <1.5 mg/dL and SGOT <60 U/mL.D. Actinomycin-DRestart at 5096 dose when the toxicity decreases to grade 0.Increase the dose by 2596 increments if tolerated.E. Hold all the following drugs when bilirubin >5.0 mg/dL orSGOT >180 U/mL:CCNUBCNU5-FluorouracilCytosine arabinosideDacarbazine (DTIC)Procarbazine*38\168\2*
