Extension of the Calvert formula to patients with severe renal insufficiency

Oguri, Tomoyo; Shimokata, Tomoya; Ito, Isao; Yasuda, Yoshinari; Sassa, Naoto; Nishiyama, M; Hamada, Akinobu; Hasegawa, Yoshinori; Ando, Yumiko

doi:10.1007/s00280-015-2769-9

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…It is also unclear whether this formula can be used accurately in patients with severely impaired kidney function. Furthermore, nonrenal clearance has been reported to be smaller than the constant “25” [ 116 ]. Therefore, it should be noted that carboplatin may be overdosed in patients with severely impaired kidney function because the ratio of nonrenal clearance is relatively high compared to GFR.…”

Section: Body Size Kidney Function and Clearancementioning

confidence: 99%

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Yanagita,

Muto,

Nishiyama

et al. 2023

Clin Exp Nephrol

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Section: Body Size Kidney Function and Clearancementioning

confidence: 99%

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Yanagita,

Muto,

Nishiyama

et al. 2023

Clin Exp Nephrol

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“…Oguri et al 7,15 reported they had evaluated the Calvert formula in Japanese cancer patients with inulin clearance, the gold standard for the estimation of GFR. They found that the Calvert formula using GFR calculated by inulin clearance overestimated the actual carboplatin clearance with a mean prediction error of 14.3%.…”

Section: Discussionmentioning

confidence: 99%

Treatment of advanced ovarian cancer with carboplatin and paclitaxel in a patient undergoing hemodialysis: Case report and literature review

Yang¹,

Han²,

Xu³

et al. 2022

Hemodialysis International

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A 69-year-old woman under maintenance hemodialysis was diagnosed with advanced ovarian cancer. We treated the patient with combination chemotherapy using paclitaxel and carboplatin. She experienced grade 4 thrombopenia on day 8 of the third course. The area under the concentration versus time curve (AUC) of platinum was 3.5 mg/mlÁmin. The interval between chemotherapy and hemodialysis was shortened starting with the fourth course. The AUC of platinum was then found to be 1.8 mg/mlÁmin. After seven courses of chemotherapy, the patient's CA 125 serum level dropped from 1317 to 42.6 U/ml. Nevertheless, the patient presented with long periods of severe myelosuppression. In patients on hemodialysis receiving such chemotherapy, the AUC of each cycle should be closely monitored and the dialysis schedule should be adjusted as need to reduce the risk of bone marrow suppression.

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“…However, the measured AUC in the first cycle unexpectedly exceeded the target AUC by about 20%, resulting in the development of grade 4 hematologic toxicities. A prior report concluded that Calvert’s formula causes CBDCA overdosing by overestimating CBDCA clearance in adult patients with severe renal insufficiency, including those undergoing hemodialysis, because this formula was originally developed using pharmacokinetic data from Caucasian patients with a GFR ranging from 33 to 135 mL/min [ 5 , 10 ]. This might explain why the measured AUC exceeded the target AUC in our patient, although this has not been investigated in studies with large numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

Investigation of tolerability and quality of life for carboplatin-based chemotherapy in an elderly urothelial carcinoma patient undergoing hemodialysis: a case report

Kondo

Naiki

Hotta

et al. 2018

J Pharm Health Care Sci

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BackgroundTo our knowledge, no studies have evaluated the safety of carboplatin (CBDCA)-based chemotherapy in hemodialysis patients > 80 years-old. In addition, the impact of CBDCA-based chemotherapy on such elderly patients’ quality of life (QOL) is unknown. We report a case of gemcitabine plus CBDCA chemotherapy treatment in an 81-year-old man with metastatic urothelial carcinoma undergoing hemodialysis.Case presentationThe optimal CBDCA dose and hemodialysis timing were determined by monitoring the measured area under the concentration–time curve (AUC) of CBDCA. This was used because the AUC of CBDCA is correlated with hematologic toxicities, especially nadir thrombocytopenia, and CBDCA is easily dialyzed during hemodialysis. In the first cycle, a 160 mg CBDCA dose, calculated using Calvert’s formula (target-AUC: 5), was administered on day 1. Hemodialysis was performed for 3 h, starting 2 h after the end of the CBDCA infusion. The measured-AUC was 5.96 mg/mL min in the first cycle, after which the patient developed grade 3/4 hematologic toxicities. Thus, in the second cycle, the CBDCA dose was reduced to 135 mg and the time interval between CBDCA infusion and hemodialysis was shortened to 1 h, according to the results of a pharmacokinetic study performed using parameters from the first cycle. The measured-AUC in the second cycle was 4.97 mg/mL min, and hematologic toxic effects decreased to grade 2. Stable disease according to the Response Evaluation Criteria in Solid Tumors was demonstrated after the second and third cycles. QOL scores determined using a short-form questionnaire (SF-36) after 2 cycles were not significantly lower than pretreatment values.ConclusionsCBDCA-based chemotherapy is clinically acceptable in hemodialysis patients aged > 80 years, and this systemic chemotherapy can be a treatment option in such elderly patients undergoing hemodialysis. However, the measured-AUC should be monitored, as the actual AUC is unpredictable in hemodialysis patients. This is due to the influence of various factors that may be different for each patient, such as the patient’s residual renal function and hemodialysis duration and conditions, especially in elderly patients, who have a higher risk of chemotherapy-induced neutropenia.

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Extension of the Calvert formula to patients with severe renal insufficiency

Abstract: For adult patients with severe renal insufficiency, the Calvert formula causes carboplatin overdosing by overestimating the carboplatin clearance.

Cited by 9 publications

References 18 publications

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Treatment of advanced ovarian cancer with carboplatin and paclitaxel in a patient undergoing hemodialysis: Case report and literature review

Investigation of tolerability and quality of life for carboplatin-based chemotherapy in an elderly urothelial carcinoma patient undergoing hemodialysis: a case report

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