Official European Society of Oncology Pharmacy Blog

CARBOPLATIN DOSING: What is your experience? (join poll)

At the annual meeting of HOPA (Hematology/Oncology Pharmacy Association) a panel discussion showed clearly that pharmacists miss a uniform standard for carboplatin dosing.

Carboplatin dosing is calculated using estimates of a patient’s renal function. A variety of formulas have been used: Pros and Cons on these methods are well known.  (Table)*.

Table. Carboplatin Dosing Formulas
Name of Formula Computation
Egorin For chemotherapy-naive patients: Carboplatin dose mg/m2 = (0.091 × [CrCl/BSA]) × ([pretreatment platelet count-platelet nadir desired/pretreatment platelet count] × 100) + 86
Calvert formula For heavily pretreated patients: Total carboplatin dose (mg) = (target AUC) × (GFR + 25)
Chatelut formula Carboplatin clearance = (0.134 × kg) + ([1 if male, 0.686 if female]) × 218 × kg) × (1 – [0.00457 × age])/serum creatinine (mg/dL) × 88.4 Dose = CrCl × AUC
AUC, area under the curve; BSA, body surface area; CrCl, creatinine clearance; GFR, glomerular filtration rate

* Kate O’Rourke The pharmacis`s news source. 2013(40)

There is uncertainty regarding which weight should be used for calculating CrCl and how the equation should be adjusted for obesity. The Cockcroft-Gault formula was designed and validated using actual body weight. Actual body weight should be used in most non-obese patients. Adjusted body weight, however, is appropriate for patients with a body mass index greater than 30 kg/m.

A lot of institutions use the lower limit of serum creatinine assay parameters.
In the article – Overestimation of carboplatin doses is avoided by radionuclide GFR measurement. [British Journal of Cancer (2012) 107, 1310–1316] – the authors Craig et al. recommend that the Cockcroft-Gault should only be used if rGFR (radionuclide GFR) is unavailable.

Dr. Doris Haider

Please Join our poll..

Would you support a standard that states

  1. Cockcroft-Gault is the preferred equation to calculate CrCl in the Calvert equation
  2. Adjusted body weight is recommended for estimating renal function in obese patients
  3. Clinicians should round up low CrCl values to their institutional lower limit of normal?

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This entry was posted on June 24, 2013 by .

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