Carboplatin dosing based on measurement of renal function — experience at the Peter MacCallum Cancer Institute

Millward, Michael; Webster, Lorraine K.; Toner, Guy C.; Bishop, James F.; Rischin, Danny; Stokes, Kerrie H.; Johnston, Val; Hicks, Rodney J.

doi:10.1111/j.1445-5994.1996.tb01925.x

Cited by 55 publications

(30 citation statements)

References 24 publications

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“…The 51 Cr-EDTA clearance method (Chantler et al, 1969) is widely accepted as being accurate and reproducible and was used in many of the initial studies used to derive carboplatin dosing formulae in Europe. Other isotope-based methods, such as those using iodothalamate or DTPA have been shown to be equivalent (Perrone et al, 1990;Millward et al, 1996). However, these methods are relatively costly and are not available in many parts of the world ( 51 Cr-EDTA is not licensed for this use in the USA).…”

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confidence: 99%

Estimation of glomerular filtration rate in cancer patients

et al. 2001

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The frequent need to obtain an estimate of renal function in cancer patients, not least for targeting carboplatin dose, has led to a number of approaches to estimate glomerular filtration rate (GFR). This study aimed to develop a simple and reliable method to estimate GFR using readily-available patient characteristics. Data from 62 patients with estimates of 51 Cr-EDTA clearance were analysed to determine the most appropriate formula relating this method of measuring GFR to patient characteristics. The population pharmacokinetics of 51 Cr-EDTA were analysed using NONMEM to evaluate the influence of each covariate. The formulae derived were then validated using a further 38 patients and compared with those obtained using existing formulae 51 Cr-EDTA clearance (GFR) was positively related to Dubois surface area, negatively related to age, and inversely related to serum creatinine (SCr). Females had lower 51 Cr-EDTA clearance than males. The enzymatic method of SCr assay gave more reliable results than the Jaffe colorimetric method. A measure of creatine kinase significantly improved the estimation of GFR. The new formula produced estimates of GFR which were less biased (Mean Prediction Error = –3%) and more precise (Mean Absolute Prediction Error = 12%) than Cockcroft and Gault (–8% and 16%) or Jelliffe (–15% and 19%) estimates. The formulae developed here can be used to provide reliable estimates of GFR, particularly in regard to targeted dosing of carboplatin. © 2001 Cancer Research Campaign http://www.bjcancer.com

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confidence: 99%

Estimation of glomerular filtration rate in cancer patients

et al. 2001

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“…These assessments have usually been compared to CrCl, determined by the 24-h urine collection (Chow and Schweizer, 1985;Pesola et al, 1993;Cochran and St John, 1993). There have also been a number of comparisons of the C&G approximation with [Tc 99m ] DTPA, Cr 51 EDTA and other direct measures of GFR (Davila and Gardner, 1987;Robinson et al, 1990;Kesteloot and Joossens, 1996;Millward et al, 1996;Poole et al, 2002). These assessments have almost uniformly concluded that the C&G approximation underestimates GFR for normal and moderately reduced levels of renal function.…”

Section: Discussionmentioning

confidence: 99%

“…Any such estimate needs to be accurate, convenient and inexpensive, and consequently should be a noninvasive formula-based method, which does not require multiple blood samples or tedious urine collection. Creatinine clearance (CrCl) measurement, through 24-h urine collection, has been used to estimate renal function; however, the reliability of this method is very much dependent on an accurate and complete urine collection, and is therefore frequently unsuitable (Davila and Gardner 1987;McDermott et al, 1987;Chambers et al, 1990;Luke et al, 1990;Robinson et al, 1990;Tsubaki et al, 1993;Millward et al, 1996). Various equations and nomograms have been developed to estimate CrCl from serum creatinine (Scr) concentration (Jelliffe, 1973;Cockcroft and Gault 1976;Martin et al, 1998;Wright et al, 2001).…”

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confidence: 99%

“…An accurate measurement of GFR is possible by measuring the clearance of the radiolabelled isotopes such as technetium-99m diethyl triamine penta-acetic acid ([Tc 99m ] DTPA) and chromium 51-ethylene diamine tetra-acetic acid (Cr 51 EDTA) (Rehling et al, 1984;Fawdry et al, 1985;Peters, 1991;Millward et al, 1996). The aim of this study was to compare measured GFR [Tc 99m ] DTPA with estimated CrCl -calculated by the C&G method in patients with Scr levels o0.06 mmol l À1 , and determine implication of rounding Scr to 0.06 mmol l À1 .…”

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confidence: 99%

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Rounding of low serum creatinine levels and consequent impact on accuracy of bedside estimates of renal function in cancer patients

2004

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To compare glomerular filtration rate measured by technetium-99m ([Tc 99m ]) DTPA clearance with estimated creatinine clearance (CrCl) (Cockcroft and Gault (C&G) method) in patients with serum creatinine (Scr) levels o0.06 mmol l À1 , and determine the effect of rounding serum creatinine to 0.06 mmol l À1 . Patients with serum creatinine values o0.06 mmol l À1 at the time of [Tc 99m ] clearance determination were identified. Creatinine clearance was calculated by the C&G method using both actual and rounded Scr values. A total of 419 adults had GFR measured by technetium-99m diethyl triamine penta-acetic acid ([Tc 99m ] DTPA) clearance. Out of this group, 26 patients had a serum creatinine value o0.06 mmol l À1 . The C&G estimates of renal function using actual serum creatinine resulted in an overall overestimation of 12.9% when compared to [Tc 99m ] DTPA clearance. When the value of serum creatinine was rounded to 0.06 mmol l À1 , the formula underestimated renal function by À7.0%. Analysis of estimated creatinine clearance for different levels of renal function showed significant differences to [Tc 99m ] DTPA clearance. Rounding up of serum creatinine to 0.06 mmol l À1 improved the predictive ability of the C&G method for the patients with [Tc 99m ] DTPA clearance p100 ml min À1 , but worsened the effect in those 4100 ml min À1 . This work indicates that when bedside estimates of renal function are calculated using the C&G formula actual Scr should be used first to estimate CrCl. If the resultant CrCl is p100 ml min À1, then the Scr should be rounded up to 0.06 mmol l À1 and CrCl recalculated. Further assessment of this approach is warranted in a larger cohort of patients.

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“…In the elderly, however, serum creatinine is not always beneficial as a marker of renal function since creatinine production is low due to decreased muscle mass (16,17). The glomerular filtration rate (GFR) is generally used as an index of renal function and can be accurately measured through the renal clearance of either cold (inulin, iohexol) or radiolabeled (51Cr-EDTA, 99mTc-DTPA) exogenous filtration markers (18)(19)(20)(21). Nonetheless, these methods are seldom available in clinical practice because they are invasive and expensive and require the use of radioelements for isotopic clearance determination.…”

Section: Discussionmentioning

confidence: 99%

Safety creatinine clearance level for platinum chemotherapy in lung cancer patients

et al. 2011

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Abstract. The present study was carried out to evaluate whether measured-creatinine clearance (measured-CrCl) and Cockcroft and Gault-CrCl (CG-CrCl) are capable of appropriately detecting a decline in renal function in lung cancer patients, including elderly patients, and to clarify a CrCl level with which to discriminate between patients with or without renal impairment. The measured-CrCl prior and subsequent to platinum-based chemotherapy of lung cancer patients was retrospectively analyzed. Measured-CrCl and CG-CrCl were evaluated prior and subsequent to platinum-based chemotherapy for lung cancer. Measured-CrCl and CG-CrCl in 59 lung cancer patients including 25 patients aged ≥65 years were retrospectively analyzed. In patients treated with carboplatin-based chemotherapy, measured-CrCl was indicative of a decline in renal function, whereas CG-CrCl was not. The optimal measured-CrCl level was <60 ml/min post-pretreatment and >90 ml/ min at pre-treatment. In cases with pre-treatment measured-CrCl levels of >90 ml/ min, favorable renal function is necessary in order to carry out platinum-based chemotherapy in lung cancer patients, including the elderly. IntroductionLung cancer in the elderly is an increasingly common problem. Elderly patients have more co-morbid diseases and tend to tolerate toxic medical treatments more poorly than younger patients (1). Recently, however, clinical trials of platinum-based chemotherapy for selected elderly lung cancer patients with favorable conditions have been conducted, and have attracted attention to the utility of such therapy for the elderly (2,3). Cisplatin is highly effective and has a significant role in the treatment of lung cancer, but chronic ototoxicity, neurotoxicity and particularly nephrotoxicity have encouraged the development of several less toxic platinum analogues, principally carboplatin (4). Carboplatin nephrotoxicity appears to be less frequent and severe than cisplatin nephrotoxicity (4). In 1994, Thyss et al reported Cockcroft and Gault-creatinine clearance (CG-CrCl) levels in 35 patients older than 80 years who received cisplatin-based chemotherapy (5); however, there has been no additional published information regarding CrCl levels at which it is safe to perform platinum-based chemotherapy for lung cancer patients, including elderly patients.The first aim of this retrospective study was to clarify whether measured-CrCl and CG-CrCl were capable of appropriately detecting a decline in renal function. An additional aim was to clarify a measured-CrCl level with which to discriminate between lung cancer patients, including elderly ones, with or without renal impairment. Patients and methods Patients.A total of 292 patients with newly diagnosed primary lung cancer who were admitted to the Division of Respiratory Medicine, Tsukuba Medical Center Hospital between 2007 and 2009, were retrospectively analyzed. In this study, 59 of 292 consecutive lung cancer patients whose creatinine clearance was measured over a period of 24 h prior and subsequent to platinum...

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Carboplatin dosing based on measurement of renal function — experience at the Peter MacCallum Cancer Institute

Cited by 55 publications

References 24 publications

Estimation of glomerular filtration rate in cancer patients

Estimation of glomerular filtration rate in cancer patients

Rounding of low serum creatinine levels and consequent impact on accuracy of bedside estimates of renal function in cancer patients

Safety creatinine clearance level for platinum chemotherapy in lung cancer patients

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