Cancer Chemotherapy and Pharmacology

, Volume 84, Issue 1, pp 213–216 | Cite as

Qualitative and quantitative variations in liver function thresholds among clinical trials in cancer: a need for harmonization

  • Edwin Wang
  • Fei Song
  • Jessica K. Paulus
  • Douglas Hackenyos
  • Paul MathewEmail author
Short Communication



The liver is critically involved in drug metabolism pathways and the potential for hepatic toxicity is significant with specific cancer therapeutics. Variations in the definition of liver function thresholds that may generate heterogeneity of toxicity and efficacy outcomes across therapeutics trials in cancer require assessment.


A random sample of therapeutic trials in cancer (n = 500, general category), trials using hepatotoxic drugs (abiraterone, pazopanib: n = 181), trials using drugs metabolized by the liver (doxorubicin, vincristine: n = 606), and therapeutic trials in hepatic dysfunction (n = 49) were each identified on Definitions of liver function thresholds and their distribution were collated and categorized in each group.


A third of all trials listed on across the four categories failed to provide an explicit definition of liver function. Among trials with an explicit definition, a combination of bilirubin and transaminase levels was used in 33–64%, whereas a miscellaneous combination of definitions (in the general category consisting of 11 unique liver function parameters creating 17 unique combinations) was used 29–58% of the time across the four categories of studies. The Child–Pugh or National Cancer Institute Organ Dysfunction Working Group (NCI-ODWG) criteria were rarely employed (0–12% studies). Allowance for Gilbert’s disease in bilirubin thresholds was identified in only 6–23% studies and for liver metastases in 2–15% of studies.


There is a marked heterogeneity in the liver function definitions used across cancer clinical trials even when the potential for drug toxicity and altered drug metabolism is significant. Harmonization of criteria will streamline eligibility and mitigate variations in key outcomes across trials.


Liver function thresholds Clinical trials Cancer 


Compliance with ethical standards

Conflict of interest

The authors declare there are no conflicts of interest.

Supplementary material

280_2019_3821_MOESM1_ESM.doc (104 kb)
Supplementary material 1 (DOC 104 KB)
280_2019_3821_MOESM2_ESM.docx (19 kb)
Supplementary material 2 (DOCX 19 KB)


  1. 1.
    Superfin D, Iannucci AA, Davies AM. Commentary (2007) Oncologic drugs in patients with organ dysfunction: a summary. Oncologist 12(9):1070–1083. CrossRefGoogle Scholar
  2. 2.
    (2003) Guidance for industry pharmacokinetics in patients with impaired hepatic function: study design, data analysis, and impact on dosing and labeling. FDA Guidance. Accessed 30 Sept 2018
  3. 3.
    Patel H, Egorin MJ, Remick SC et al (2004) Comparison of Child-Pugh (CP) criteria and NCI organ dysfunction working group (NCI-ODWG) criteria for hepatic dysfunction (HD): implications for chemotherapy dosing. J Clin Oncol 22(14_suppl):6051–6051. CrossRefGoogle Scholar
  4. 4.
    Cancer Therapy Evaluation Program (2018) Protocol templates and guidelines | protocol development | CTEP. Accessed 30 Sept 2018
  5. 5.
    Talal AH, Venuto CS, Younis I (2017) Assessment of hepatic impairment and implications for pharmacokinetics of substance use treatment. Clin Pharmacol drug Dev 6(2):206–212. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Edwin Wang
    • 1
  • Fei Song
    • 2
  • Jessica K. Paulus
    • 3
  • Douglas Hackenyos
    • 4
  • Paul Mathew
    • 5
    Email author
  1. 1.Tufts University School of MedicineBostonUSA
  2. 2.Division of Internal MedicineTufts Medical CenterBostonUSA
  3. 3.Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonUSA
  4. 4.Pharmacy DepartmentTufts Medical CenterBostonUSA
  5. 5.Division of Hematology-OncologyTufts Medical CenterBostonUSA

Personalised recommendations