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Table 3 Criteria for irinotecan dose adjustment due to liver toxicity

From: Does a ketogenic diet as an adjuvant therapy for drug treatment enhance chemotherapy sensitivity and reduce target lesions in patients with locally recurrent or metastatic Her-2-negative breast cancer? Study protocol for a randomized controlled trial

AST/ALTAlkaline phosphatase levelDose adjustment
<  1.5 × ULN< 5 × ULNNo dose adjustment
1.5 × ULN to < 2.5 × ULN< 2.5 × ULNNo dose adjustment
2.5 × ULN to < 5 × ULN< 2.5 × ULNThe irinotecan dose will be reduced by 20%.
> 1.5 × ULN to < 5 × ULN> 2.5 × ULN to < 5 × ULN
>  5 × ULN and/or > 5 × ULN (except for bone metastases without any liver damage)If recovery is not achieved within 3 weeks, the patient will be withdrawn from the trial
  1. ALT alanine aminotransferase, AST aspartate aminotransferase, ULN upper limit of normal