Dosing of cytotoxic chemotherapy: impact of renal function estimates on dose

Ann Oncol. 2013 Nov;24(11):2746-52. doi: 10.1093/annonc/mdt300. Epub 2013 Aug 7.

Abstract

Background: Oncology clinicians are now routinely provided with an estimated glomerular filtration rate on pathology reports whenever serum creatinine is requested. The utility of using this for the dose determination of renally excreted drugs compared with other existing methods is needed to inform practice.

Patients and methods: Renal function was determined by [Tc(99m)]DTPA clearance in adult patients presenting for chemotherapy. Renal function was calculated using the 4-variable Modification of Diet in Renal Disease (4v-MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft and Gault (CG), Wright and Martin formulae. Doses for renal excreted cytotoxic drugs, including carboplatin, were calculated.

Results: The concordance of the renal function estimates according to the CKD classification with measured Tc(99m)DPTA clearance in 455 adults (median age 64.0 years: range 17-87 years) for the 4v-MDRD, CKD-EPI, CG, Martin and Wright formulae was 47.7%, 56.3%, 46.2%, 56.5% and 60.2%, respectively. Concordance for chemotherapy dose for these formulae was 89.0%, 89.5%, 85.1%, 89.9% and 89.9%, respectively. Concordance for carboplatin dose specifically was 66.4%, 71.4%, 64.0%, 73.8% and 73.2%.

Conclusion: All bedside formulae provide similar levels of concordance in dosage selection for the renal excreted chemotherapy drugs when compared with the use of a direct measure of renal function.

Keywords: carboplatin; chemotherapy; dose; glomerular filtration rate; renal function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / blood
  • Carboplatin / administration & dosage*
  • Carboplatin / blood
  • Creatinine / blood
  • Drug Dosage Calculations*
  • Female
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency / blood
  • Renal Insufficiency / drug therapy*
  • Renal Insufficiency / pathology

Substances

  • Antineoplastic Agents
  • Creatinine
  • Carboplatin