Field Kathryn M, Michael Michael
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Lancet Oncol. 2008 Dec;9(12):1181-90. doi: 10.1016/S1470-2045(08)70307-3.
The liver is fundamentally important in drug metabolism. In oncology, the astute clinician must not only understand the meaning and limitations of commonly ordered liver biochemical tests, but also be aware of which anticancer agents might induce liver dysfunction, and of the strategies for appropriate dosing of patients with pre-existing liver dysfunction. In part I of our Review, we highlighted both the importance and inadequacies of identifying serum biochemical liver abnormalities in oncology; we also discussed a lack of routine formal investigation of liver function. We summarised chemotherapy-related hepatotoxicity and other causes of liver toxic effects in patients with cancer. Here in part II, we discuss trials that have specifically assessed chemotherapy dosing strategies in the setting of overt biochemical liver dysfunction and we note their recommendations. Furthermore, we review other assessments of liver metabolic and excretory function, particularly in the setting of chemotherapy drug handling. We discuss the potential use of these metabolic probes in practice.
肝脏在药物代谢中至关重要。在肿瘤学领域，经验丰富的临床医生不仅必须了解常用肝脏生化检查的意义和局限性，还应知晓哪些抗癌药物可能导致肝功能障碍，以及针对已有肝功能障碍患者的合理给药策略。在我们综述的第一部分，我们强调了在肿瘤学中识别血清生化肝脏异常的重要性和不足之处；我们还讨论了缺乏对肝功能进行常规正式检查的情况。我们总结了癌症患者化疗相关的肝毒性以及其他导致肝脏毒性作用的原因。在第二部分中，我们讨论了专门评估明显生化肝功能障碍情况下化疗给药策略的试验，并提及了它们的建议。此外，我们回顾了对肝脏代谢和排泄功能的其他评估，特别是在化疗药物处理方面。我们讨论了这些代谢探针在实际应用中的潜在用途。
