Accurate determination of glomerular filtration rate in adults for carboplatin dosing: Moving beyond Cockcroft and Gault

Tsang, Corey; Akbari, Ayub; Frechette, Dominque; Brown, Pierre Antoine

doi:10.1177/1078155220978446

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…Recently, White-Koning et al [16] reported in a pharmacokinetic study that CKD-EPI is one of the more accurate formulas to predict carboplatin clearance in the Calvert formula. This finding has been confirmed in a recent statement article by Tsang et al [17]. For further studies, a complementary approach could be the therapeutic drug monitoring that allows prediction of unbound carboplatin clearance from carboplatin total plasma concentration [18].…”

Section: Discussionmentioning

confidence: 53%

Safety and Survival Outcomes in Lung Cancer Patients Receiving Carboplatin: Impact of Uncapped Dosage

Bozec¹,

Boulanger²,

Mongaret³

et al. 2021

Chemotherapy

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The prescription of carboplatin is commonly based on the Calvert formula, and low serum creatinine values can lead to an overestimation of the glomerular filtration rate and of the carboplatin dose. Limited data recommend to cap carboplatin dose at 800 mg, but the risk of suboptimal carboplatin dose is concerning. This study compared hematologic toxicity occurrence and survival outcomes in lung cancer patients receiving carboplatin > or <800 mg based on the Calvert formula (target area under the curve = 5 mg/mL min). Our results show more severe cytopenia in patients receiving carboplatin >800 mg with significant difference for all grades of thrombocytopenia in the uncapped group (37% patients vs. 3%, p = 0.02). For metastatic non-small-cell lung cancer patients, we also observed hematologic toxicity in the uncapped group with more severe anemia (30% of patients vs. 0%, p = 0.03) and all grades of thrombocytopenia (39 vs. 0%, p = 0.02) than the capped group. Concerning the secondary endpoint, we obtained a trend of lower progression-free survival and overall survival in patients receiving carboplatin >800 mg, but no significant difference appears for the both survival criteria. This study aims to improve the determination of carboplatin dosage to know the real impact of carboplatin capping and to find the optimum balance between excessive toxicity and substandard therapeutics outcomes.

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Section: Discussionmentioning

confidence: 53%

Safety and Survival Outcomes in Lung Cancer Patients Receiving Carboplatin: Impact of Uncapped Dosage

Bozec¹,

Boulanger²,

Mongaret³

et al. 2021

Chemotherapy

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“…In clinical practice, carboplatin dose is usually determined through the Calvert equation, most commonly using eGFR equations. 38 Two French models (Thomas, and Chatelut, n = 403 patients) demonstrated that incorporating both Scys and Scr accurately predicts CaCl. 37,39 In another cohort of 491 patients with solid tumors, the Calvert equation based on CKD-EPIcr-cys was the best equation to predict CaCl, the least biased, with the lowest mean absolute percentage error (MPAE) and the lowest P20 (percentage of patients with MPAE over 20%) when compared to all other models used to predict GFR based on Scr alone (CKD-EPI, CG, MDRD (Modification of Diet in Renal Disease Study equations), incorporated into the Calvert or Thomas/Chatelut models.…”

Section: Cystatin C As a Filtration Marker In Patients With Solid Tumorsmentioning

confidence: 98%

Serum cystatin C level can be used to estimate GFR in patients with solid tumors: PRO

Torres

2023

Journal of Onco-Nephrology

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An accurate assessment of glomerular filtration rate (GFR) is a fundamental aspect of cancer care and research. Recent studies have demonstrated that, in patients with solid tumors, GFR estimation based on serum creatinine combined with serum cystatin C presented minimal bias compared to measured GFR, may reduce race disparity when applied to race free GFR estimating equations, and improve the prediction of carboplatin clearance.

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“…In clinical practice, carboplatin dose is usually determined through the Calvert equation, incorporating eGFR. 40 Two French models (Thomas and Chatelut, n5403 patients) demonstrated that incorporating both serum creatinine and cystatin C accurately predicts CaCl. 39,41 In another cohort, the Calvert equation on the basis of CKD-EPICr-Cys was the best equation to predict CaCl and the least biased, with the lowest mean absolute percentage error and the lowest percentage of patients with mean absolute percentage error over 20% versus equations used to predict GFR on the basis of creatinine alone.…”

Section: Boxmentioning

confidence: 99%

Assessment of GFR in Patients with Cancer

Kitchlu,

Silva,

Anand

et al. 2024

CJASN

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Accurate assessment of glomerular filtration rate (GFR) is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of cancer patients have baseline chronic kidney disease (CKD), and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface-area (BSA)-adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD-EPI equations, with 2,508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (8 studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the ASON Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials.

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Accurate determination of glomerular filtration rate in adults for carboplatin dosing: Moving beyond Cockcroft and Gault

Cited by 5 publications

References 38 publications

Safety and Survival Outcomes in Lung Cancer Patients Receiving Carboplatin: Impact of Uncapped Dosage

Safety and Survival Outcomes in Lung Cancer Patients Receiving Carboplatin: Impact of Uncapped Dosage

Serum cystatin C level can be used to estimate GFR in patients with solid tumors: PRO

Assessment of GFR in Patients with Cancer

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