Acute doxorubicin toxicity relationship to pretreatment liver function, response, and pharmacokinetics in patients with acute nonlymphocytic leukemia

To determine if there is a relationship between development of acute doxorubicin toxicity, pretreatment liver function studies, and response, 64 acute nonlymphocytic leukemia patients undergoing induction chemotherapy with doxorubicin and cytosine arabinoside were evaluated. No statistically significant correlation could be found between the development of acute toxicity (mucositis) and the number or type of abnormal pretreatment liver functions. Patients receiving full doses of doxorubicin with mild hepatic dysfunction as determined by bromsulphalein (BSP) retention and serum liver function studies had the same incidence of toxicity and complete response rate as those with normal hepatic function. There was no significant difference between duration of response (P = 0.41) or survival (P = 0.17) between the two groups. Ten patients receiving a decreased dose of doxorubicin due to hepatic dysfunction had the same complete response rate but a lower incidence of toxicity as patients receiving full doxorubicin dose. Pharmacokinetic data from fluorescence plasma assays suggest no difference among patients with normal or mildly abnormal liver function studies receiving full doxorubicin doses. The results suggest that leukemia patients with mild hepatic dysfunction receiving a combination of full-dose doxorubicin and cytosine arabinoside for acute leukemia will have the same plasma pharmacokinetics, incidence of toxicity, and complete response rate as those with normal hepatic function. Reduction of doxorubicin dose in patients with abnormal liver function tests results in lower plasma concentrations, less toxicity, and the same response rate, but may also yield a shorter duration of response and survival.