Risks and benefits of phase I liver dysfunction studies: should patients with severe liver dysfunction be included in these trials?

• Published in: Investigational new drugs Vol. 35; no. 3; pp. 386 - 391
• Main Authors: Fountzilas, Christos, Stuart, Selena, Hernandez, Brian, Bowhay-Carnes, Elizabeth, Michalek, Joel, Sarantopoulos, John, Karnad, Anand, Patel, Sukeshi, Weitman, Steven, Mahalingam, Devalingam
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2017; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Albumin; Alkaline phosphatase; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Aspartate transaminase; Bile; Bilirubin; Cancer; Classification; Clinical trials; Clinical Trials, Phase I as Topic; Criteria; Female; Health risks; Humans; Liver; Liver cancer; Liver Diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoplasms - drug therapy; Oncology; Patient Selection; Patients; Pharmacokinetics; Pharmacology; Pharmacology/Toxicology; Poisons; Serum albumin; Short Report; Survival; Survival Analysis; Transaminase; Young Adult; Liver dysfunction; Phase I study; Prognostic model; Survival
• ISSN: 0167-6997; 1573-0646
• DOI: 10.1007/s10637-017-0425-4

Summary Introduction The goal of organ dysfunction Phase I trials is to characterize the safety and pharmacokinetics of novel agents in cancer patients with liver or kidney dysfunction, but the clinical benefit is not well established. Methods We reviewed 170 patients across 15 liver dysfunction studies at our institution, grouped based on the NCI-Organ Dysfunction Working Group criteria or Child-Pugh Score. Results The median survival for the entire cohort was two months and just one month amongst patients with severe liver dysfunction. Patients with normal or mild liver dysfunction, absence of tumor in liver, good performance status, higher serum albumin and lower bilirubin, aspartate transaminase and alkaline phosphatase had improved survival by univariate analysis. Serum albumin and liver function classification remained significant by multivariate analysis. Conclusion Given poor survival of patients with liver dysfunction, we need better criteria, such as albumin levels, for optimally selecting patients for liver dysfunction studies.