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Carboplatin dosing obese patients: Carboplatin Dosing in Overweight and Obese Patients: A Single-Center Experience

In prospective clinical trials, it was demonstrated that individualisation resulted in a more precise prediction of the effect of carboplatin in terms of myelosuppression, especially thrombocytopenia—the dose-limiting toxicity Jodrell et al, ; Gore et al,

Matthew Cox
Friday, April 16, 2021
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  • Clin Cancer Res12 2101 Nov

  • Purpose: The purpose of this study was to determine the potential utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in underweight, normal weight, overweight and obese patients.

  • Beijnen JH. Affiliations 1 author 1.

  • Basen-Engquist K, Chang M.

  • Increased awareness is needed in the oncology community to highlight unique considerations and confirm quality assurance when estimating renal clearance in the Calvert formula in overweight and obese patients.

Publication types

The chemotherapy combination regimens that each patient received were not well balanced, thus the addition of other cytotoxic chemotherapy obsse, such as paclitaxel, increases the risk and severity of myelosuppression when compared with monotherapy. Clin Cancer Res12 2101 Nov If the creatinine at the time of dose modification is higher than the baseline creatinine value, they recommended using the current higher value. Patient data were accessed through electronic medical records.

  • Clin Cancer Res12 2101 Nov Either your web browser doesn't support Javascript or it is currently turned off.

  • Several patient-specific factors covariates were evaluated for displaying a significant influence on PK parameters.

  • They recommended capping the maximum carboplatin dose based on target area under the curve AUC.

  • There are some limitations to our investigation.

  • Eur J Cancer Clin Oncol 23 : — Conclusion: Obese ovarian cancer patients treated with carboplatin experience substantially less toxicity than normal weight women.

Predictive performance of ten equations for estimating creatinine clearance in cardiac carboplatin dosing obese patients. Although the creatinine clearance is always slightly higher than obexe GFR, the two estimates of renal function are used interchangeably in the Calvert formula. Affiliations 1 author 1. Results This study indicated that lean body mass was the best weight descriptor in underweight and normal weight patients, while adjusted ideal body weight was the best weight descriptor in overweight and obese patients.

Advanced search. Cancer Chemother Pharmacol. Curr Oncol Rep. To browse Academia.

Rodenhuis S. Beijnen JH. Patient data were accessed through electronic medical records. But obesity alone shouldn't be the reason," he said.

Google Scholar. Anticancer Res 14 : — Clin Obese patients Res. Recently, the American Society of Clinical Oncology ASCO updated its guidelines on the treatment of obese patients with cancer to recommend full, weight-based doses of chemotherapy. Prevalence and trends in obesity among U. Discussion Dosing in cancer chemotherapy is traditionally based on BSA and, even nowadays, most new drugs are approved in doses per unit BSA. Change history 16 November This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication.

In contrast, this strategy aims to adjust the dose to achieve a target AUC based on patient-specific factors. StrainJ. J Clin Oncol 19 : — This dosing formula for conventional-dosed carboplatin has been approved by regulatory agencies, for example, FDA in Should we cap doses?

Publication types

Abstract Purpose: The purpose of this study was to determine the potential utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in underweight, normal weight, overweight and obese patients. Siegert W, Rick O, Beyer J High-dose chemotherapy with autologous stem-cell support in poor-risk germ cell tumors. Results: This study indicated that lean body mass was the best weight descriptor in underweight and normal weight patients, while adjusted ideal body weight was the best weight descriptor in overweight and obese patients. J Natl Compr Canc Netw.

In order to examine whether there was a higher probability of a patient experiencing a certain type of toxicity if exposure of carboplatin was higher, the occurrence of toxicity was related to the area under the concentration—time profiles AUC of high-dose carboplatin calculated from individual PK analysis. Bone Marrow Transplantation Pinkel D. The use of body surface area as a criterion of drug dosage in cancer chemotherapy. Chemotherapy dosing in obese patients with cancer—the need for evidence-based clinical practice guidelines. Almost one third of Americans are currently considered obese. Later examinations have shown either an over- or underprediction of the actual determined BSA Gehan and George, ; Mitchell et al,

Although these formulas are convenient to use, and they conserve time, there is a trade-off dozing accuracy and consistency with regard to the determination of GFR. Data collection included demographic information, pretreatment and posttreatment complete blood count and nadir, concurrent cytotoxic chemotherapy, and any supporting documentation confirming treatment delays and dose reductions. J Oncol Pharm Pract25 718 Oct Cited by: 21 articles PMID: However, a flat dose based on the population carboplatin clearance performed better in all weight categories than the use of the Cockcroft-Gault equation with diverse weight descriptors. In April, ASCO released a new clinical practice guideline on the appropriate dosing of chemotherapy drugs given to obese adult patients with cancer.

Ann Oncol. For instance, increased adipose tissue body fat may indirectly alter Vd by Carboplatin is hydrophilic in nature oebse would, therefore, not impairing regional blood flow to tissue and affecting plasma distribute well through adipose tissue. Cheymol G. The GFR is often substituted by the cal- in obese patients may affect parameters such as volume of culated creatinine clearance CLcr.

InGrochow et al have highly questioned the rationale of this dosing strategy and thereby stimulated research in this field. Based on the published, peer-reviewed clinical trials, the data ;14 9 In addition to the relations of individual types of toxicity, we found a statistically significant correlation between AUC and overall nonhaematological toxicity associated with the high-dose treatment. Download PDF. Results All 29 patients entering the study were evaluated and are reported in the following.

  • Cancer Chemother Pharmacol, 2

  • A review and suggestions for further research.

  • In fact, most data suggest that myelosuppression is the same or less pronounced in obese patients vs healthy-weight patients receiving full weight-based chemotherapy doses, according to the study report. Prospective studies are needed to substantiate these preliminary clinical data.

Keywords Carboplatin Obesity Ovarian cancer. J Natl Cancer Inst 82 : — Cheymol G. The carboplatni of observations per patient ranged from 13 to Am J Prev Med. In this issue of the Journal of Hematology Oncology Pharmacy, Nightingale and colleagues address the issue of dosing carboplatin in obese patients. Bone Marrow Transplantation

Carboplatin dosing in obese obese patients with ovarian cancer : A Gynecologic Oncology Group study. Any additional adjustment that is then made because of obesity or any other parameter renders the estimate a guess. Timothy G. FleitzR. A higher AUC would be associated with a higher risk of unacceptable toxicity. Full size image.

Carpolatin AUC - What is AUC?

A retrospective analysis was conducted using data from patients who received carboplatin therapy during the period between January and January This minimum value was subsequently increased to 0. In patients with abnormally low serum creatinine they recommended using a minimum serum creatinine value of 0.

Ann National task force on obesity ireland 2011 ford. In: Gynecologic oncologyVol. The tion was adopted without adequate carbop,atin of the relation- study data also suggests that ifosfamide distributes into body ship between dose, BSA, and other parameters of body size. Obesity related quality-adjusted life years lost in U. Individualised dosing strategy for high-dose carboplatin in patients with germ cell cancer.

The number of observations per patient ranged from 13 to J National task force on obesity ireland 2011 ford Pract. As such, a patient with a BMI of All rights reserved. P icov is the individual predicted PK parameter according to the covariate model eq. Korean age If you're wondering what would your age be from a Korean perspective, use this Korean age calculator to find out. Calvert et al presented a dosing formula to individualise the dose based on the patient's renal function, pretreatment with cytotoxic agents and chemotherapy protocol monotherapy or combination therapy.

  • Individualized dosing is the current practice to control plasma drug exposure of carboplatin.

  • J Clin Oncol.

  • Extremely high exposures in an obese patient receiving high-dose cyclophosphamide, thiotepa and carboplatin. Of note, this patient was extremely obese with a BMI of

  • This was a retrospective study design, and we were not able to control for the heterogeneity that comprised our small study population.

  • Body weight categories are based on the National Institutes of Health guidelines on the identification of overweight and obese adults.

If the carboplatin dosing obese patients at the time of dose modification is higher than the baseline creatinine value, they recommended using the current higher value. The recommendations also call for modified dosing in patients with comorbidities such as heart, kidney, or lung diseasewhether they are obese or not. Both formulas were developed and validated using non-IDMS creatinine values. Sarah M. Read article at publisher's site DOI : Patients were categorized based on actual body weight kg and height cm into 1 of 5 groups, including:. In fact, most data suggest that myelosuppression is the same or less pronounced in obese patients vs healthy-weight patients receiving full weight-based chemotherapy doses, according to the study report.

Sabbatini, MD Saturday, September 1, Carboplatin-based chemotherapy remains the mainstay of treatment for many patients with gynecologic malignancies. The secondary objective was to identify presence of grade 3 or 4 thrombocytopenia, per the National Cancer Institute Common Toxicity Criteria for Adverse Events, treatment delays, and dose reductions. J Oncol Pharm Pract25 718 Oct The literature is limited in terms of guiding decisionmaking within the oncology community for addressing the influential variables within the Calvert formula in overweight and obese patients. Lily Y. Despite the study limitations, our results contribute to existing data regarding prescribing patterns within our institution and highlight unique considerations when calculating carboplatin dosage with the Calvert formula in overweight and obese patients.

Carboplatin dose - Calvert formula

Lulla, MDCarboplatun T. Clin Cancer Res, 7 Furthermore, in overweight and obese populations, body weight actual body weight vs ideal body weight applied to an SCr-based formula may overestimate GFR. Patients were categorized based on actual body weight kg and height cm into 1 of 5 groups, including:. The review excluded leukemia studies and did not address dosing of novel targeted agents.

Carboplatin is excreted cagboplatin exclusively by carboplatin dosing obese patients kidneys. In patients with abnormally low serum creatinine they recommended using a minimum serum creatinine value of 0. Objective: The primary objective of this study was to evaluate physician prescribing practices with the Calvert formula in overweight and obese patients. The MDRD formula has been re-expressed using the new IDMS creatinine values but cannot be used for carboplatin dosing as it has not been validated for this purpose. With two-thirds of Americans either overweight or obese, and increasing prevalence of the problem worldwide, it is crucial to ensure that the care of obese patients with cancer not be compromised because of limited-dose chemotherapeutic treatment simply because of the patient's obesity, said Dr.

Existing data suggest a strong correlation between carboplatin AUC and dose-limiting myelosuppression, specifically thrombocytopenia. Patients were categorized based on actual body weight kg and height cm into 1 of 5 groups, including:. The investigators concluded that the traditional Carboplatin dosing obese patients formulas used to calculate carboplain dosage should be used until more data become available regarding the use of the MDRD equation in this population. Overestimation may result in divergent carboplatin dosages that correlate with dose-limiting thrombocytopenia, treatment delays, and dose reductions. Objective: The primary objective of this study was to evaluate physician prescribing practices with the Calvert formula in overweight and obese patients. We did not identify any independent risk factors predicting dose reductions or therapy delays resulting from toxicity ie, race, sex, age, cancer diagnosis, baseline platelet count, and previous myelotoxic chemotherapy, concurrent radiation therapy, or performance status.

Prediction of creatinine clearance from serum creatinine. Ann National task force on obesity ireland 2011 ford, 12 These initiatives are limited, because they do not address the body weight that should be applied to the Cockcroft-Gault equation in special populations of overweight and obese patients. The study demographics included mean age of However, a flat dose based on the population carboplatin clearance performed better in all weight categories than the use of the Cockcroft-Gault equation with diverse weight descriptors. To sign up for our newsletter or print publications, please enter your contact information below. Smart citations by scite.

J Clin Oncol. Med Oncol. Download PDF. Gurney H.

In: Gynecologic oncology. J Clin Oncol 10 : — Although it is fosing patients to add toxicity grades, we think that this method is of great interest, and can be justified since the WHO classification system provides a 5-grade scale for all types of toxicity from none to life-threatening toxicity. Patients were stratified based on body mass index BMI. The equation developed is only applicable for patients with normal or slightly impaired renal function, that is, for patients usually receiving carboplatin.

It describes the variation of a drug's concentration in the blood's plasma as a function of time. The covariates selected were then carbopatin in the PK model in order to establish the final relationships between the covariates and the PK parameters. Pflugers Arch : — Drip Rate Calculator. Chemotherapy dosing in obese patients with cancer—the need for evidence-based clinical practice guidelines. The number of observations per patient ranged from 13 to The results of predictive performance of the four established strategies for conventional carboplatin are presented in Table 4.

Cancer Chemother Pharmacol57 225 Aug To schedule or learn more, read this. Toxicity of high-dose carboplatin: ultrafiltered and not total plasma pharmacokinetics is of clinical relevance.

Data collection included demographic information, pretreatment and posttreatment complete blood count and national task force on obesity ireland 2011 ford, concurrent cytotoxic chemotherapy, and any supporting documentation confirming treatment delays and dose reductions. Europe PMC requires Javascript to function effectively. Body weight categories are based on the National Institutes of Health guidelines on the identification of overweight and obese adults. J Hematol Oncol Pharm. The study conclusions are limited, because the goal was not specifically to evaluate dose divergence and clinical outcomes in overweight and obese patients, but the study does provide some data regarding surrogate markers within the Calvert formula. Abstract Read article for free, via Unpaywall a legal, open copy of the full text.

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Clin Pharmacokinet, 4 April 2, early release online. Abstract Purpose The purpose of this study was to determine the potential utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in underweight, normal weight, overweight and obese patients. Substances Antineoplastic Agents Creatinine Carboplatin. When actual body weight is applied to an SCr-based formula for use in the Calvert formula, overweight and obese patients may have carboplatin AUCs greater than targeted because of overestimation of renal clearance. In the past, multiple assays were used to measure serum creatinine, resulting in considerable interlaboratory variability in the reporting of creatinine values. Jessica M.

The literature is limited in terms of guiding decisionmaking within the oncology community for addressing the influential carboplatin dosing obese patients within the Calvert formula in overweight and obese cxrboplatin. Body weight categories are based on the National Institutes of Health guidelines on the identification of overweight and obese adults. Share this article Share with email Share with twitter Share with linkedin Share with facebook. Lulla, MDRammurti T. The complete guideline recommendations, as well as clinical tools and other resources, can be accessed at www. Nephron, 1

Ther Drug Carboplatun carboplatin dosing obese patients : — Since it was our aim to propose a simple dosing guideline calculation for clinical practice, in the final individual dosing equation figures have been rounded off. Any additional adjustment that is then made because of obesity or any other parameter renders the estimate a guess. J Clin Oncol 16 : —

  • Read article at publisher's site DOI : Functional range of creatinine clearance for renal drug dosing: a practical solution to the controversy of which weight to use in the Cockcroft-Gault equation.

  • J Oncol Pract. Individual Bayesian PK parameters, that is, individual predicted PK parameters, were generated based on the population parameters of the model and on the individual concentration—time data.

  • J Oncol Pharm Pract25 718 Oct

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  • J Oncol Pharm Pract25 121 Aug Traditionally, CrCl has been measured using or hour urine collections for creatinine or using contrast agents such as iohexol or radiolabeled agents.

  • Prior to start of the study, the protocol was approved by the Ethics Committee of the University hospital and all patients gave written informed consent. Cockcroft DW.

Eur J Cancer Clin Oncol 23 : — Carboplafin, the ADME of weight x 0. Kidney Failure Risk Calculator. AB - Background: Carboplatin dosing for gynecologic malignancies is traditionally based on the Jelliffe formula that lacks dose adjustment for weight. The results of predictive performance of the four established strategies for conventional carboplatin are presented in Table 4. Titration Use our titration calculator to determine the molarity of your solution. Rights and permissions From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.

Table 1 View larger version. In fact, most data suggest that myelosuppression is the same or less pronounced in obese patients vs healthy-weight patients receiving full weight-based chemotherapy doses, according to the study report. Although these formulas are convenient to use, and they conserve time, there is a trade-off in accuracy and consistency with regard to the determination of GFR. Clin Cancer Res15 1028 Apr Am J Med, 6 To schedule or learn more, read this.

Mean PK parameters and significant covariates were regarded as fixed-effects parameters and interindividual and residual variability as xarboplatin parameters. Appropriate systemic therapy dosing for obese adult patients with cancer: ASCO guideline update. For individualising carboplatin in HDCT, we have developed a population PK model to characterise the population and the variability. In contrast to conventional chemotherapy, carboplatin is still dosed per unit of body surface area BSA in high-dose chemotherapy protocols in clinical practice. The predictive performance of the two most important strategies, proposed by Calvert et al and Chatelut et alfor predicting carboplatin CL of the HDCT patients studied was evaluated using the mean prediction error MPE as a measure of bias and the root mean squared prediction error RMSE as a measure of precision according to Sheiner and Beal,

With two-thirds of Americans either overweight or obese, and increasing prevalence of dosnig problem worldwide, it is crucial to ensure that the care of obese patients with cancer not be compromised because of limited-dose chemotherapeutic treatment simply because of the patient's obesity, said Dr. Clin Cancer Res, 21 Cancer Chemother Pharmacol85 309 Jan April 3, early release online. J Hematol Oncol Pharm.

Search Search articles by subject, keyword or author. To browse Academia. Carboplatin dosing in overweight and obese patients with normal Lancet Oncol. Enter the email address you signed up with and we'll email you a reset link. Lillie D. A short summary of this paper.

Substances Antineoplastic Agents Creatinine Carboplatin. Clin Cancer Res12 carboplatin dosing01 Nov Increased awareness and education regarding unique considerations with the Calvert formula in overweight and obese populations should be directed to medical oncology physician prescribers, pharmacists, and healthcare providers within the oncology community to establish quality assurance within the institution or practice site. Extremely high exposures in an obese patient receiving high-dose cyclophosphamide, thiotepa and carboplatin. There was also inconsistency with regard to the number of carboplatin treatment cycles that patients received in relation to documented dose reductions or treatment delays. Ekhart slz. Affiliations 1 author 1.

Carboplatin-based chemotherapy remains the mainstay of treatment for many patients with gynecologic malignancies. Download PDF. Nagoya J Med Sci7601 Feb The recommendations also call for modified dosing in patients with comorbidities such as heart, kidney, or lung diseasewhether they are obese or not.

Findings from the OCTOPUS Consortium of trial data patjents that weight-based chemotherapy dosing may improve outcomes for obese patients with colorectal cancer. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of carboplatin dosing years of follow-up. Results: This study indicated that lean body mass was the best weight descriptor in underweight and normal weight patients, while adjusted ideal body weight was the best weight descriptor in overweight and obese patients. Theoretically, cancer patients might be overdosed if the chemotherapy dose is based on actual body weight rather The extent to which compounds are affected by obesity than on ideal body weight. Click here to sign up.

Ann Hematol 76 : — Table 2 Population pharmacokinetic parameters carboplztin the basic PK without covariates and final PK model with covariates Full size table. Results All 29 patients entering the study were evaluated and are reported in the following. For each step the explained percentage of the interindividual variability of a significant covariate was calculated according to Draper and Smith, :.

Significant covariates identified were finally included into the PK model final PK model. Korean Age Calculator. Therefore, we must consider the dose-reduction questions in light of the medical literature, which suggests that such reductions may compromise patient outcomes. Area under the curve AUC is a term that frequently used in pharmacokinetics. To browse Academia. Individual Bayesian PK parameters, that is, individual predicted PK parameters, were generated based on the population parameters of the model and on the individual concentration—time data.

The Jelliffe equation is used by most gynecologic oncology group protocols, and gynecologic malignancies did not comprise our study population, which explains why the equation may not have been used. The study conclusions are limited, because the goal was not specifically to evaluate dose divergence and clinical outcomes in overweight and obese patients, but the study does provide some data regarding surrogate markers within the Calvert formula. TOP Print Edition. Carboplatin has been approved by the US Food and Drug Administration for the treatment of ovarian cancer and has been used off-label for the treatment of many solid tumors, including lung, head and neck, endometrial, breast, and cervical cancers. Fifty percent of the patients were obese, and the mean BMI was

Another theoretical reason is the influ- depends on the lipophilicity of the drug. J Clin Oncol 20 : 81— This article has been updated. This study assessed the association between BMI and outcome for ovarian cancer patients treated with carboplatin-based chemotherapy. Bone Marrow Transplantation Individualised dosing strategy for high-dose carboplatin in patients with germ cell cancer.

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The chemotherapy combination regimens that each patient received were not well balanced, thus the addition of other cytotoxic chemotherapy agents, such as paclitaxel, increases the risk and severity of myelosuppression when compared with monotherapy. The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles. Download PDF. Cited by: 28 articles PMID: Am J Med, 6

Mean body weight was applied to the SCr-based formula in 1 patient. Existing data suggest a strong correlation obese patients carboplatin AUC and dose-limiting myelosuppression, specifically thrombocytopenia. In patients with abnormally low serum creatinine they recommended patientw a minimum serum creatinine value of 0. Affiliations 1 author 1. However, the panel did recommend fixed dosing for certain chemotherapy agents, including vincristine, due to the risk of neuropathy; bleomycin, due to the potential for lung scarring; and carboplatin, which should be dosed based on kidney function. Cited by: 27 articles PMID: The Jelliffe equation is used by most gynecologic oncology group protocols, and gynecologic malignancies did not comprise our study population, which explains why the equation may not have been used.

  • Sarah M.

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  • Creation and evaluation of a cancer chemotherapy order review guide for use at a community hospital.

Furthermore, in overweight and obese patients, body weight actual body weight vs ideal body weight applied to an SCr-based formula may overestimate GFR. Results: This study indicated that lean body mass was the best weight descriptor in underweight and normal weight patients, while adjusted ideal body weight was the best weight descriptor in overweight and obese patients. Our results demonstrate that physician prescribers utilized the Cockcroft-Gault equation to estimate GFR in all patients. Fifty percent of the patients were obese, and the mean BMI was Cancer Chemother Pharmacol, 3

Pharmacokinetic considerations in obesity. Cancer Chemother Pharmacol 36 : — A prerequisite for improved dosing is the study of the PK and their relationships to the effects. Semin Oncol 19 : —

The SCr-based formula utilized pattients the prescribing physician, the body weight applied to the formula, the target AUC, and the treatment cycle number were collected from the chemotherapy order. Jessica M. Purpose: The purpose of this study was to determine the potential utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in underweight, normal weight, overweight and obese patients. Conclusion: The use of actual body weight in the Cockcroft-Gault equation to estimate glomerular filtration rate in the Calvert formula was associated with a high percentage of adverse clinical events.

Methods: Clearance values obtained from carboplatin dosing obese patients fits using NONMEM were compared to predicted carboplatin clearances calculated using the modified Calvert formula in which creatinine clearance was calculated carboplagin the Cockcroft-Gault equation using diverse weight descriptors. J Clin Oncol, 11 Recent history Saved searches. Background: Serum creatinine—based formulas are used to estimate glomerular filtration rate when calculating carboplatin dosage with the Calvert formula. Abstract Purpose The purpose of this study was to determine the potential utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in underweight, normal weight, overweight and obese patients.

  • There are some limitations to our investigation. J Oncol Pract.

  • Area under the curve AUC is a term that frequently used in pharmacokinetics. Development of an individualised dosing strategy was based on the target AUC concept and individual clearance prediction.

  • The Jelliffe equation is used by most gynecologic oncology group protocols, and gynecologic malignancies did not comprise our study population, which explains why the equation may not have been used.

  • Significant covariates identified were finally included into the PK model final PK model. Prior to start of the study, the protocol was approved by the Ethics Committee of the University hospital and all patients gave written informed consent.

Iohexol Cooperative Study Group. Patients and carboplatin dosing obese patients oatients continue to wear masks while at MSK, including people who are fully vaccinated. Patients were excluded if baseline laboratory values were not available. Table 1 View larger version. Jul Formulae recently proposed to estimate renal glomerular filtration rate improve the prediction of carboplatin clearance.

Thus, patienys data clearly suggest that BSA is not a rational factor to base high-dose carboplatin dosing upon. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. To reduce interindividual variability, we performed an analysis to identify significant covariates and assess their magnitude of influence on interindividual variability. The patient population displayed a large difference 2. Except for docetaxel, where BSA has been found to be a main predictor for clearance Bruno et al,recent investigations on various drugs demonstrated that BSA is poorly correlated with pharmacokinetic parameters de Jongh et al, ; Loos et al, ; Mathijssen et al,

The Chatelut equation showed the highest deviations ppatients accuracy and precision. For nephrotoxicity, ototoxicity and PNS toxicity, the relative frequency of developing toxicity was increased with higher exposure, most pronounced for renal toxicity. Carboplatin dose. You are using a browser version with limited support for CSS. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer.

  • Read article at publisher's site DOI :

  • Other types of toxicity will have to be considered instead Wright et al, ; Dosijg et al, ; Patients et al,and the therapeutic index for the patients has to be newly defined. Except for docetaxel, where BSA has been found to be a main predictor for clearance Bruno et al,recent investigations on various drugs demonstrated that BSA is poorly correlated with pharmacokinetic parameters de Jongh et al, ; Loos et al, ; Mathijssen et al,

  • In the past, multiple assays were used to measure serum creatinine, resulting in considerable interlaboratory variability in the reporting of creatinine values.

  • Carboplatin-based chemotherapy remains the mainstay of treatment for many patients with gynecologic malignancies.

All laboratories were expected to comply by December 31, Increased awareness is needed in the oncology community to highlight unique considerations and confirm quality assurance when estimating renal clearance in the Doisng formula in overweight and obese patients. J Oncol Pharm Pract25 121 Aug Ekhart and colleagues assessed the utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in special body weight populations. There are some limitations to our investigation. Either your web browser doesn't support Javascript or it is currently turned off. Although these formulas are convenient to use, and they conserve time, there is a trade-off in accuracy and consistency with regard to the determination of GFR.

Share this article Share with email Carboplatin dosing obese with twitter Share with linkedin Share with facebook. Read article at publisher's site DOI : Cited by: 21 articles Obwse In our study, applying actual body weight to estimate GFR for use in the Calvert formula did correlate with a high percentage of clinical events, including grade 3 or 4 thrombocytopenia and dose reductions secondary to toxicity. We did not identify any independent risk factors predicting dose reductions or therapy delays resulting from toxicity ie, race, sex, age, cancer diagnosis, baseline platelet count, and previous myelotoxic chemotherapy, concurrent radiation therapy, or performance status. Patients were categorized based on actual body weight kg and height cm into 1 of 5 groups, including:.

Basen-Engquist K, Chang M. Cheymol National task force on obesity ireland 2011 ford. One pwtients to keep in mind that these values are based on the developed equation. In vitro pharmacokinetic study of the novel anticancer agent E red blood cell and plasma protein binding in human blood By Miroslav Ravic. Based on the correlations found, they defined a target AUC associated with a platelet nadir that was considered to be tolerable.

People also viewed…. A higher AUC would be associated with a higher risk of unacceptable toxicity. Furthermore, a little toxicity may be a good thing. Gurney H.

Carboplatin dosing in overweight and obese patients with normal Lancet Oncol. All rights reserved. Serum creatinine. Patients were not recruited if one or more organs were more than slightly impaired kidney, e. Cancer Chemother Rep 54 : —

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