Cancer patients
with adequate hepatic or renal function are typically studied in clinical
trials. Since most anticancer agents are cleared via hepatic
or renal mechanisms, dose adjustments would be anticipated.
Yet when the drug
is approved, dosing modification guidelines are often lacking for patients who
have varying degrees of hepatic or renal dysfunction.
Therefore,
oncologists may start therapy with an empirically-derived lower starting dose
due to the perception that a patient with organ dysfunction would have poorer
tolerability due to increased toxicity.
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