Ensuring Safe Prescribing Practice and Understanding the Impact of Hepatic Impairment on Anticancer Drugs in Cancer Patients: A Scoping Review
(2024) , 41 pages
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EnsuringSafePrescribingPracticeandUnderstandingtheImpactofHepaticImpairmentonAnticancerDrugsinCancerPatientsA.pdf
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- Abstract
- Introduction: Liver dysfunction is a prevalent complication in cancer patients, often resulting from the disease itself or as a side effect of various treatments. Given the liver's crucial role in drug metabolism and clearance, hepatic impairment (HI) can significantly alter the pharmacokinetics (PK) of anticancer agents, potentially leading to suboptimal therapeutic outcomes or increased toxicity. Despite its importance, there is a lack of clear guidelines for the safe prescription of these drugs in patients with HI, resulting in inconsistent clinical practices and potential harm. Objectives: Provide a comprehensive overview of the existing literature on the impact of HI on the PK of anticancer drugs, identify the variability in HI classification and assessment methods, and highlight key concepts and gaps to support clinicians in safe prescribing. Methods: The review followed the PRISMA-ScR guidelines. A comprehensive search was conducted in the PubMed database from February 2024 to May 2024. Results: The review included 31 studies, comprising 22 primary sources and 9 secondary sources. Significant variability was observed in the classification of HI, utilising Child-Pugh, NCI systems, and custom LFT-based stratifications. Inconsistencies in inclusion and exclusion criteria, small patient groups, and a lack of comprehensive data on the aetiology of HI were prominent issues. Most studies documented significant alterations in the PK of anticancer drugs due to HI. Discussion:The variability in HI classification and study criteria complicates the generalisation of findings and highlights the need for harmonised research protocols. Narrative reviews consistently emphasised the liver's role in drug metabolism and the necessity for precise dose adjustments in patients with HI. Clinicians must carefully assess liver function, understand the impact of HI on drug metabolism, and consider individual patient factors to prescribe anticancer drugs safely. This review provides valuable insights and a framework for evidence-based decision-making in treating cancer patients with liver dysfunction. Conclusion: This scoping review identifies critical gaps and areas for future investigation, emphasising the need for standardised HI assessment and dosing recommendations. Addressing these gaps will be crucial for improving clinical outcomes and ensuring safe and effective cancer treatment in patients with hepatic impairment.
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Montay, E. (2024). Ensuring Safe Prescribing Practice and Understanding the Impact of Hepatic Impairment on Anticancer Drugs in Cancer Patients: A Scoping Review. https://hdl.handle.net/2078.5/217918