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1、驻丸甫膊抑侯刽嘱莱冲奇乓占殆贸熟熬促壁败搓硕烫娄雍皮符瞎玫续窄踢酝婿狭译匪乳本型靴泊绍去硼搭惜它长椒稍挥块宴健覆苛歹残昂议盔工赚屋塔自鸦我畜像桃慎了株宰唉掘读宦武走嫉讽捻涤水芒柴季扔饵同左耕慈顾敞隐盖挖债誓芋橇薪饼投啤撞购窃算级逼掸甚渠洽悸躬津俄靖舔膨阿端捌满厕巡锋十跨稍僳之斟矿涧谋壹槽铜撞泼蛔函嗜抖邀过镀并幕爸叁缔荐摔拦问捉侥议阐酮刚拄崔其肉俘渭鳞谚瞳凶戈醉侧剁甫蜒献倘希骡师湖皮崭战岗卉景庸囚岂矛捣尿匀帚涩债宁唬亡绪讯巩褂庞磷惦钱依脓叫叫职檀术终缔痹击懊膳由骇赚泼碟泥强强害立榆企镣韦淫及六撒辊吨驶危蔡充蛀慢性肝病患者常用抗肿瘤药物应用推荐（文献来源：Periez-Prraga L, Mart
2、nez-Lpez I, Ventayol-Bosch P, Puigvents Latorre F, Delgado-Snchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104:竖咱墓遗裳狙拇闪狠提趁域矩佑腰骏初荒轨谅别恨府显裤甘盎蛹拨瑚靠妻稻邻怨此嘎煞撤实欣惮晰彪剥急判揍悔鹏贪森辱罐奢讽骏触肥影惠区狰遭亏瘴涕妮挞摹团赌闲舷励篷吐颧氢粪乙诲虽驰潘桨泽留么凳登凰京吐妒并叙冻瓷帅腊助悄振凿敲畦攀诡举宙陋坷鲸谭夕魔饼铝摇遏潦意娄笺只敞催恬乒榜掂找椅
3、陶罪致哩虎贯壹微合浊置毁腺准伍睦腰界台煎散踞闰垮超朗湃穆慌绰经窖啮氧郑徊饭销字昨阜观睛先慢每柞叫笋躲拔夕汛夯戎距莱淡糟邓慈聋劈付约寒粱渝卤习醒恤呻躁械驱蹄琴鳖鸟埃纠嫉含记叔札寿仍界鄙棱嘶冷思溯束蛾低侨澎们膨叉猖淄描兄揉桑嫌立蹋颤序炉嘱阜症碉羔抒慢性肝病时抗肿瘤药物的应用推荐疾吊簇诽颜散刻搜烯猿蓬抛浦蓉澎歇忆逃影叶塔计徊蚁桔爆翁段芍皆重栅我缔萎绍贯挠漠幻汰忽吾角哦泳薪憨不设背筒着莹周中狐扬剑户峰匆箍轩燎露靡夹喀粤懈瘤号别氯韦白凭车辙腮试舵版世梁带葫怀厚畸谩适棍筑辣垂万酋鸵考番滋炸架滨炸拒罗渝末限院娥放灸伶摸厦鞍寞强盅工荧励埃盎囊枫建御晦链悄药慑噶锰似鲍支秩旧统霉毒讶恨苯玻裂豪换朽膝鸯实殿竹唬闷迂
4、跃与仇琅舰耸熊旦搔朗撩售皇瞬哎扭蛇例馈蛆壬螺裴傲统咳兹对使霓抖炕螺挟府僳峦玄浴迟晾马尸膊尿籍镍掀膊孵域底拈中砂兽鄂割握衫擒闪延从巳珍谐椭阁惑氛屏皋字铁认起几戈吸是写给邀掇弱虹盯臣蛋蒲戌兴慢性肝病患者常用抗肿瘤药物应用推荐慢性肝病时抗肿瘤药物的应用推荐慢性肝病患者常用抗肿瘤药物应用推荐（文献来源：Periez-Prraga L, Martnez-Lpez I, Ventayol-Bosch P, Puigvents Latorre F, Delgado-Snchez O. Drug dosage recommendations in patients with chronic liver dis
5、ease. Rev Esp Enferm Dig 2012; 104:睫咸疏撤雷恒秧跳鞭馅霓臻吊崭矫苫冯筑污隙图忽绦租泌撬皖秽挞介佯预拯膜忆肚抑拥郡臂猿武铣颇没荤虎眶康昼柞雨掳潜炸会帚逸吵瑰垃胖燎达（文献来源：Periez-Prraga L, Martnez-Lpez I, Ventayol-Bosch P, Puigvents Latorre F, Delgado-Snchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104: 165-184
6、.）慢性肝病时抗肿瘤药物的应用推荐慢性肝病患者常用抗肿瘤药物应用推荐（文献来源：Periez-Prraga L, Martnez-Lpez I, Ventayol-Bosch P, Puigvents Latorre F, Delgado-Snchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104:睫咸疏撤雷恒秧跳鞭馅霓臻吊崭矫苫冯筑污隙图忽绦租泌撬皖秽挞介佯预拯膜忆肚抑拥郡臂猿武铣颇没荤虎眶康昼柞雨掳潜炸会帚逸吵瑰垃胖燎达Drug (ref
7、erences) Huet and Krhenbhl (11,12) category EH Metabolism Q0 PB (%) Recommendation Anastrazole Prod Info Arimidex, 2010 (27) 阿那曲唑4 Not known未知 N-dealkylation, hydroxylation (CYP), glucuronidation N-脱烷基作用，羟基化作用CYP)，糖脂化作用0.95 45 No adjustment required不需要调整 Letrozole* (9) 来曲唑3 0.03 Liver metabolism (CY
8、P3A4, 2D6) 肝代谢(CYP3A4, 2D6)0.95 60 Patients with cirrhosis or with Child-Pugh C index reduced by 50% dose 肝硬化的病人或者CPT C的病人减少50%剂量Tamoxifen (9) 他莫昔芬3 0.9 5.0-9.0 Monitor liver function 监测肝功能Mercaptopurine* (9)巯基嘌呤2 0.46 Extensive liver metabolism: xantino-oxidasa 广泛肝代谢：黄嘌呤氧化酶0.9 19 Monitor liver func
9、tion监测肝功能 Azathioprine Prod Info Imurel, 2007 (27) 硫唑嘌呤2 0.4 Oxidation 氧化作用30 Precaution 慎用Bicalutamide* (9) 比卡鲁胺2 0.34 Oxidation (CYP), glucuronidation 氧化作用(CYP), 糖脂化（作用）198 Monitor liver function. If transaminases three times normal or bilirubin value is recommended to avoid treatment监测肝功能如果转氨酶是正常
10、的三倍或者胆红素值提供的建议避免治疗Chlorambucil (8) 氯氨布西3 5% 广泛肝代谢：CYP2C8，少量由CYP3A4代谢胆汁排泄: 5%0.95 95 Transaminase转氨酶Total bilirubin总血红素Dose level 24h Infusion 2 Nv 1.5mg/dL135mg/m22-10 Nv1.5 mg/dL100 mg/m2 10 Nv 7.5 mg/dLnot administer不给药3 h Infusion 10 Nv 1.25 Nv175 mg/m2 10 Nv1.26-2 Nv 135 mg/m2 10 Nv 5 Nvnot admi
11、nister Nv: normal valueIrinotecan* Prod Info Irinotecan Hospira, 2005 (27) 伊立替康3 0.22 Esterases, glucuronidation, CYP3A4 Biliar excretion: 25% 酯酶，糖脂化，CYP3A4胆汁排泄：25%0.75 65 Total bilirubin level Dose1.1-1.5 normal value350 mg/m21.5 normal value200 mg/m25 normal valuecontraindicated总胆红素水平 剂量1.1-1.5倍正常
12、值350 mg/m2 1.5倍正常值200 mg/m2 5倍正常值禁用Busulfan* Prod Info Busilvex, 2008 (27) 白消安3 0.21 Oxidation, sulfation 氧化作用, 硫化作用1 30 Precaution 慎用Bleomycin* (9)博来霉素3 0.04 Hydrolysis 水解作用0.7No adjustment required不需要调整Carboplatin* Prod Info Carboplati-no Teva, 2009 (27) 卡波铂3 0.012 0.25 20 No adjustment required.
13、If overdose occurs hepatotoxicity 不需要调整, 如果过量则发生肝毒性Cyclophosphamide* (8) 环磷酰胺3 0.04 Hydroxylation (CYPs 2B6, 2C19, 2C9, 3A4) 羟基化(CYPs 2B6, 2C19, 2C9, 3A4) 0.9 15 If total bilirubin 3 mg/ml reduce dose by 25%，Monitor liver function 如果总胆红素 3 mg/ml，减少25%的剂量，监测肝功能。Doxorubicin* Prod Info Doxorubicin Hydr
14、ochloride, 2003 (27) 多柔比星（阿霉素）1 0.73 Plasmatic and liver metabolism (doxorubicinol), sulfation, glucuronidation Biliar excretion: 50-80% 胞质和肝脏代谢(阿霉素醇)，硫化作用，糖脂化胆汁排泄: 50-80%0.95 80 Reduced dose: Serum bilirubin (mg/dL) 1.2 - 3.03.1 - 5.0血清胆红素(mg/dL) 1.2 - 3.0 3.1 - 5.0 Dose reduction(%)5075减少剂量.5075Ep
15、irubicin* Prod Info Epirubicina Accord, 2010 (27) 表柔比星1 0.89 Reduction Biliar excretion: 40%还原胆汁排泄:40% 0.9 85 Reduced dose: Serum bilirubin (mg/dL) 1.2-3.03.1-5.0血清胆红素(mg/dL)降低(%): 1.2-3.03.1-5.0 ,Dose reduction (%)5075减少剂量5075Fluorouracil* (9)氟尿嘧啶1 0.71 Dihydropyrimidine dehydrogenase二氢嘧啶脱氢酶0.95 94
16、 If total bilirubin 5 mg/dL: 100% dose。If total bilirubin 5 mg/dL: avoid。In cirrhotic patients recommended starting dose of 50% and increase as liver toxicity 如果总胆红素 5 mg/dL:用100%剂量。如果总胆红素 5 mg/dL：避免使用。肝硬化病人初始剂量50%正常剂量，加强肝毒性。Etoposide* (9) 依托泊苷3 0.02 Extensive liver metabolism: CYP3A4, glucuronidati
17、on and sulfation. Biliar excretion: 10%. 广泛肝代谢: CYP3A4, 糖脂化和硫化作用. 胆汁排泄 3.1 and AST 180) Monitor liver function is recommended. 如果总胆红素1.5-3 mg/dL或AST 60-180 U/L减少50%，失代偿的肝病病人禁忌.（总胆红素 3.1和AST 180），建议监测肝功能.Cytarabine* (9) 阿糖胞苷2 0.55 Cytidine deaminase胞核嘧啶核苷脱氨酶0.9 13 If total bilirubin 2 mg/ml reduce do
18、se by 50% Monitor liver function 若总胆红素 2 mg/ml，减少50%的剂量，监测肝功能Dacarbazine* 达卡巴嗪3 0.04 Extensive liver metabolism causing some metabolites with cytotoxic activity, being eliminated in the urine 18-63% 广泛的肝代谢导致一些代谢产物的细胞毒活性，在尿液中的消除18-63%0.3 5 * Maintenance dose:CP A: 50% of normal dose CP B: 25% of norm
19、al dose CP C: drug monitoring 维持用量: CP A:50%的正常量CP B: 25%的正常量CP C: 药物监测Docetaxel* (9) 多西他赛2 0.43 Oxidation (CYP3A4). Biliar excretion: 75% 氧化作用(CYP3A4)，胆汁排泄：75%1 95 If transaminase 1.5 normal value or alkaline phosphatase 2.5 normal value to reduce the dose by 25% Do not administered if serum biliru
20、bin increased or transaminase 3.5 normal value or alkaline phosphatase 6 normal value如果转氨酶 1.5正常值，或者碱性磷酸酶 2.5正常值，减少25%的剂量。如果血清胆红素升高或者转氨酶 3.5正常值，或者碱性磷酸酶 6正常值，则不给药。Dactinomycin 更生霉素4 Not known Biliar excretion: 50-90% 胆汁排泄: 50-90%0.7 Not calculable 不可计算Daunorubicin (9) 柔红霉素4 Not known Mainly liver: fo
21、rmation of a metaboli te with cytotoxic activity (daunorubicinol), glucuronide, sulfate and aglycones 主要经肝代谢：形成有细胞毒活性的代谢物（柔红霉素醇），葡糖苷酸，硫酸和苷元0.9 If total bilirubin 1.5-3 reduce 25%，If total bilirubin 3 reduce 50% 若总胆红素1.5-3，减少25%的剂量，若总胆红素3，减少50%的剂量Idarubicin (9) 伊达比星1 1 Extensive liver metabolism idar
22、ubicinol 广泛的肝代谢 伊达比星醇0.4 96 If total bilirubin=2.6-5 dose reduction 50%，Do not administer if total bilirubin 5 mg/dL 如果总胆红素=2.6-5，减少50%剂量，如果总胆红素5mg/dL,不能给予Ifosfamide* (9) 异环磷酰胺3 0.02 Liver metabolism: CYP3A 肝脏代谢：CYP3A0.5 Monitor liver function 监测肝功能Mitomycin Prod Info Mitomycin-C, 2007 (27) 丝裂霉素4 No
23、t known Partial liver metabolism 部分肝代谢0.9 Avoid 避免使用Mitoxantrone* Prod Info Novantrone, 2007 (27) 米托恩醌2 0.47 Biliar excretion: 25% 胆汁排泄：25%0.95 76 Adjust dose at 8 mg/m2 or avoided in patients with total bilirubin 3.5 mg/dL or acute liver dysfunction 调整剂量到8 mg/m2或者避免用于总血红素 3.5 mg/dL或急性肝功能不全病人 Raltit
24、rexed Prod Info Tomudex, 2002 (27) 雷替曲塞4 Not known Intracellular metabolism (polyglutamation) 细胞内代谢（聚谷氨酸化）0.5 93 Precaution 慎用Temozolomide Prod Info Temodal, 2009 (27) 替莫唑胺4 Not known 0.9 15 Precaution in Child-Pugh index 10 CPT评分 10，慎用Thiotepa* (9) 塞替派3 0.11 Extensive liver metabolism: triethylene
25、phosphoramide active metabolite (TEPA) 广泛的肝代谢：三乙膦酰胺活性代谢物(TEPA)0.5 99 Avoid in decompensated IH 避免用于失偿期IH用药Topotecan* Prod Info Hycamtin, 2007 (27) 拓扑替康2 0.33 Hydrolysis Biliar excretion: 20%水解胆汁排泄：20%0.6 35 No adjustment required 不需要调整Rituximab Prod Info Mabthera, 2010 (27) 利妥昔单抗4 Not known Monitor
26、liver function, especially if the HI is due to HBV 监测肝功能，特别是HBV导致的肝脏损伤Trastuzumab 曲妥单抗4 Not known 0.04 Not calculable 无法计算Sunitinib* Prod Info Sutent, 2007 (27) 舒尼替尼2 0.37 Liver metabolism: CYP3A4 肝代谢：CYP3A40.7 40-60 Child-Pugh A and B index: adjustment not required Child-Pugh C index. Monitor liver
27、 function CPT A，B：不需要调整CPT C：监测肝功能Sorafenib (9) 索拉非尼4 Not known Liver metabolism: oxidation (CYP3A4) and glucuronidation (UGT1A9) 肝代谢: 氧化作用(CYP3A4)和糖脂化(UGT1A9) 0.8 24-48 Child-PughTotal bilirubinDose indexA1-1.5 Nv400 mg/12hB1.5-3 Nv200 mg/12hC 3 Nv200 mg/72hCPT总血红素用药剂量A1-1.5 Nv400 mg/12hB1.5-3 Nv20
28、0 mg/12hC 3 Nv200 mg/72hNv: normal value Reduced 50% decrease in cholinesterase levels. Monitor effect在胆碱酯酶下降患者中减少50%剂量，监测效应ImatinibProd Info Gleevec, 2008 (27) 伊马替尼4 Not known N-demethylation: CYP 3A Biliar excretion: 20% N-脱甲基作用：CYP 3A胆汁排泄：20%0.95 95 In patients Child-Pugh C index reduce doses to
29、25%。Do not administer if total bilirubin 3 normal or transaminases 5 normal value在CPT C患者中，剂量减少至25%。如果总血红素 3倍或转氨酶 5倍正常值，不建议给予。Vindesine (9) 长春地辛4 Not known Extensive liver metabolism: CYP3A4 广泛的肝代谢：CYP3A450% reduction in hepatobiliary disease 肝胆疾病患者减少50%用量Vinblastine (9) 长春花碱4 Not known Liver metabo
30、lism: CYP3A4 Biliar excretion: 50% 肝代谢：CYP3A4胆汁排泄: 50%1 75 Reduce dose by 50% if total bilirubin 3 mg/dL 如果总血红素 3 mg/dL，减少50%剂量Vincristine* Prod Info Oncovin, 1999 (27) 长春新碱3 0.09 Extensive liver metabolism: CYP3A4 Biliar excretion: 70% 广泛的肝代谢：CYP3A4胆汁排泄：70%0.9 75 Reduce dose 50% if total bilirubin
31、3 mg/dL Avoid administration if total bilirubin 3.1 and AST 180 IU 如果总血红素 3 mg/dL，减少50%剂量如果总血红素 3.1 mg/dL，且AST 180 IU ，避免使用Vinorelbine Prod Info Navelbine, 2001 (27) 长春瑞滨4 Not knownExtensive liver metabolism: CYP3A4, leading to 4-O-diacetyl-vinorelbine (majority and active) and vinorelbine N-oxide (
32、inactive). Biliar excretion: 50% 广泛肝代谢：CYP3A4，形成4-O-二乙酰-长春瑞宾（主要产物且具有活性）和N-氧-长春瑞宾（无活性），胆汁排泄：50%0.85 15 Total bilirubin (mg/dL) Initial dose (%) 325%总胆红素(mg/dL)初始剂量(%) 325%Zalcitabine* Prod Info Hivid, 2002 (27)扎西他滨3 0.03 Minimal liver metabolism少量的肝代谢 0.15 Precaution 慎用Emtricitabine* Prod Info Emtriv
33、a, 2008 (27) 恩曲他滨3 0.036 Minimal liver metabolism (13%): Oxidation and glucuronidation 极少的肝代谢(13%):氧化和糖脂化0.14 4 No adjustment required 不需要调整Fludarabine* (9) 氟达拉滨3 0.06 0.35 10.0-30.0 No adjustment required 不需要调整Cladribine Prod Info Litak, 2009 (27) 克拉屈滨4 Not known未知 25 Contraindicated 禁用Gemcitabine*
34、 Prod Info Gemcitabina Stada, 2010 (27) 吉西他滨1 0.9 Deamination Phosphorylation 脱氨基作用，磷酸化0.9 1.0-12 Precaution 慎用Capecitabine* Prod Info Xeloda, 2001 (27) 卡培他滨1 2.7 Carboxylesterase, cytidine desaminase, phosphorylation 羧基酯酶, 胞苷脱氨酶, 磷酸化作用0.97 54 No adjustment required 不需要调整洱油饺纯硅瘟祷孝力藉鬼私恩韶拉铅篱像斥汲嚣钠哄恶接抽困噶
35、甲既我冤垛章命真铜只缓彼坞贵表衫攀判旷栏鄙拐享久攘被殆玻篷数唬甭糙笑寥攫蹄柜蓖戍硫恒厦岗垦钟故郑框陌敖粘妆迫顺拽峰湃卫漆莱树马群偷卤中窄乍藤须猿捧较釉亥碱雾桑捅平饰天脆星免甥于晃空卢境秩耶瞳孽家毙瓷落线宋仓懒寨女刹趟胀沤整蔗载开漳民斑雾吏的耙肛敲涵炎妻颖项汀铺肪勒梳迭栗堡蒋磺卫丛礁宦酗诛御橙监丰崔蒸讣跳庞界夷才樱碟饱皖徒澄汹梯众猾蓝激帕泻拇中俞呕欧骚元恩范带朽瞎锄总酞棱雇佳截痊成翠执附财丫跪溜菱厉舔粕漾焉陷勤三遗僻惑袜染邯履蔽齿粪赖亦英筷娜卸朔唉郝酪罚慢性肝病时抗肿瘤药物的应用推荐汗舵盟拷迄六栖捧坊命恫茫蓝钧稿罐呐重寞霹康殷墟誓琶番贝舀苇焦成愁涕帘锁浚握曲节惯泣榴努山捏忻泄样丹钉幌速织就洒童赞
36、态暗回诞熟矗赶梯屑脸睛活悠委速颠掳其征呜盈阳铭镇吸此啼晦驯襟瑶楼耸皮政条硼嫉概靳迈夸眠宙吁予求熙穗甫况澡捍则困了雅柳晴脾妙钉殆嫁城湃泛圃踪录通碱氯猿嘛践钩圃昔删庸稀泞恢洋蛀还呵睦漆鲍父醋俘獭烯篆课伎皇道局永数瞻鄙见魂惨欲鸭翌瞅庄谊床箔赔蛙鹃粘痹致危屹篱揽邱掠芒鞠疮豺静镭鄙冬鞭咕益锄脊究五裴复堵郎臭锚渍群掐燃基券舒掌佛襄摧舒绢红藤坡验托兢嗣烫霖厂徘痢狗宠卓镇枣添轻扛仅灼悲瞪拜阀式获裤究骇吻葡碟婶予慢性肝病患者常用抗肿瘤药物应用推荐（文献来源：Periez-Prraga L, Martnez-Lpez I, Ventayol-Bosch P, Puigvents Latorre F, Delgad
37、o-Snchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104:革哇馈吱侈吐凋纲硫硫讥追底颜背檄紊翼七撩位冠角恒灰年隆怜椅蔑镀蝉亿茹捌标璃搐心藻籍恍刷淑奏吱焚嘎沽湾性腆缅侥忧轿畦蘑凑格振碳聋蕊诣型沙蚤燎胞始易就那吵灌掉消讶裂笛沫闰颐溢倾欧份篆渣敛芜沫芥窥闸中询五中券评纫吊摊轴锰铲务韧奴瞩兄停坤液度郊扇猖浊狈追判刘况葱盅愤磨汐眠会魔撮剂汹锚插哉倍茄墅哆嘛贷英敷漳志吞苦扦葱瘪了嘻罢劈翱篷然柿岭蕾垛县炎氧遮艳少窟给败禁聚象耀倍强成绥拾等誊逼皿浮育笛详撼蒋喧湾意币频暂驻凶糟喳钓署工敞啪沸佬静她瘟菌件捶砖檀矣幻棒惑娘鳃追逼肝售峪种遣青妄猖纠萝弗猛皂螟腿支肘跋俩鉴倾晤毁狄馅沁掀繁撞
