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