Summary The question of whether UK oncologists follow current anthracycline dose modifications when treating patients with liver dysfunction was addressed through a questionnaire. Oncologists were asked the dose of doxorubicin or epirubicin they would prescribe for a woman with breast cancer and liver metastases who had one of four different patterns of abnormal liver chemistry. In each case, the median dose of anthracycline that would have been prescribed was close to that currently recommended. There was, however, wide variation in the dose that oncologists said they would prescribe, some avoiding an anthracycline altogether, whereas others would give full-dose treatment. Medical oncologists would prescribe a significantly lower dose of anthracycline than clinical oncologists for a patient with the most severely disturbed liver tests. Overall, medical oncologists were also significantly more likely to prescribe epirubicin. These results show the need for new, widely accepted anthracycline dose modifications for patients with liver dysfunction.Keywords: liver dysfunction; anthracycline; doxorubicin; epirubicin; dose The anthracyclines, doxorubicin and epirubicin, are among the most widely used cytotoxics in the treatment of adult solid tumours. These drugs are largely eliminated by hepatic metabolism and biliary excretion. Although dose reductions are recommended for patients with liver dysfunction (Pharmacia and Upjohn data sheets), it is not known how widely they have been adopted. Benjamin et al (1973) first reported increased toxicity in eight patients with liver metastases treated with full-dose doxorubicin. This excess toxicity was abrogated in patients with liver dysfunction treated with a reduced dose of doxorubicin. Subsequently, Camaggi et al (1982) showed reduced epirubicin clearance in six patients with liver metastases. These reports led to the current recommendations for doxorubicin and epirubicin doses based on serum bilirubin or bromosulphthalein (BSP) clearance. However, the question of whether liver dysfunction significantly affected anthracycline clearance remained unclear (de Valeriola, 1994) (1996), were invited to reply to a postal questionnaire describing the following clinical situation:'A woman of 50 with early breast cancer was initially treated by conservation surgery with radiotherapy and adjuvant CMF. Three years later she had a cutaneous relapse and was started on tamoxifen. Six months later she developed abdominal pain and was found to have liver metastases on ultrasound scan. Currently she remains quite active and has no evidence of bone metastases but her appetite is reduced. ' The oncologists were told that the aim of the survey was to establish the patterns of anthracycline use in patients with liver metastases and abnormal liver tests. They were also informed that it would be used to establish whether there is a need for new dose recommendations in these patients. The oncologists were asked the dose (as a percentage of full dose) and choice of anthracycline (doxorubicin,...