Medical Oncology

, 31:848 | Cite as

Dose adjustment of carboplatin in patients on hemodialysis

  • Achuta K. Guddati
  • Parijat S. Joy
  • Creticus P. Marak
Short Communication

Abstract

Carboplatin is one of the most prescribed cytotoxic drug, which is extensively used in the treatment regimens of several malignancies. The therapeutic efficiency of carboplatin has been found to correlate the area under curve (AUC). The Calvert formula has been extensively used to determine the dose of carboplatin for a fixed AUC and glomerular filtration rate (GFR). This formula has also been used in patients with end-stage renal disease on hemodialysis by assuming that the GFR is zero. This is applicable to patients who receive hemodialysis within 12–18 h after carboplatin infusion. After the first 24 h, a majority of the carboplatin is bound to proteins is not easily dialyzable and hence continues to remain in the blood stream despite repeated sessions of hemodialysis. We derive a correction factor to calculate the resultant AUC in such patients. The analysis done by using this correction factor shows that the AUC can increase by eightfold in patients who received the adjusted dose but whose hemodialysis was delayed beyond 24 h after infusion. The correction factor proposed here can also be used to calculate the dose adjustment required a priori in patients who may receive delayed hemodialysis. It is also useful to predict the AUC and estimate the resultant toxicity in such patients.

Keywords

Carboplatin AUC Dose Hemodialysis 

References

  1. 1.
    Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet. 1999;354(9173):93–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Fischereder M, Jauch KW. Prevalence of cancer history prior to renal transplantation. Transpl Int. 2005;18(7):779–84. doi:10.1111/j.1432-2277.2005.00109.x.PubMedCrossRefGoogle Scholar
  3. 3.
    Launay-Vacher V, Oudard S, Janus N, Gligorov J, Pourrat X, Rixe O, et al. Prevalence of renal insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer. 2007;110(6):1376–84. doi:10.1002/cncr.22904.PubMedCrossRefGoogle Scholar
  4. 4.
    Janus N, Thariat J, Boulanger H, Deray G, Launay-Vacher V. Proposal for dosage adjustment and timing of chemotherapy in hemodialyzed patients. Ann Oncol. 2010;21(7):1395–403. doi:10.1093/annonc/mdp598.PubMedCrossRefGoogle Scholar
  5. 5.
    Yao X, Panichpisal K, Kurtzman N, Nugent K. Cisplatin nephrotoxicity: a review. Am J Med Sci. 2007;334(2):115–24. doi:10.1097/MAJ.0b013e31812dfe1e.PubMedCrossRefGoogle Scholar
  6. 6.
    Boisdron-Celle M, Lebouil A, Allain P, Gamelin E. Pharmacokinetic properties of platinium derivatives. Bull Cancer. 2001;88 Spec No:S14–9.Google Scholar
  7. 7.
    Egorin MJ, Van Echo DA, Tipping SJ, Olman EA, Whitacre MY, Thompson BW, et al. Pharmacokinetics and dosage reduction of cis-diammine(1,1-cyclobutanedicarboxylato)platinum in patients with impaired renal function. Cancer Res. 1984;44(11):5432–8.PubMedGoogle Scholar
  8. 8.
    Calvert AH, Newell DR, Gumbrell LA, O’Reilly S, Burnell M, Boxall FE, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol. 1989;7(11):1748–56.PubMedGoogle Scholar
  9. 9.
    Mazumdar M, Smith A, Tong WP, Motzer RJ. Calvert’s formula for dosing carboplatin: overview and concerns of applicability in high-dose setting. J Natl Cancer Inst. 2000;92(17):1434–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Chatelut E, Canal P, Brunner V, Chevreau C, Pujol A, Boneu A, et al. Prediction of carboplatin clearance from standard morphological and biological patient characteristics. J Natl Cancer Inst. 1995;87(8):573–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Newell DR, Pearson AD, Balmanno K, Price L, Wyllie RA, Keir M, et al. Carboplatin pharmacokinetics in children: the development of a pediatric dosing formula. The United Kingdom Children’s Cancer Study Group. J Clin Oncol. 1993;11(12):2314–23.PubMedGoogle Scholar
  12. 12.
    Ishibashi T, Yano Y, Oguma T. A formula for predicting optimal dosage of nedaplatin based on renal function in adult cancer patients. Cancer Chemother Pharmacol. 2002;50(3):230–6. doi:10.1007/s00280-002-0488-5.PubMedCrossRefGoogle Scholar
  13. 13.
    Sato S, Fujiwara H, Oishi T, Shimada M, Machida S, Takei Y, et al. Evaluation of a formula for individual dosage of nedaplatin based on renal function. Cancer Chemother Pharmacol. 2012;69(3):599–603. doi:10.1007/s00280-011-1739-0.PubMedCrossRefGoogle Scholar
  14. 14.
    Inoue A, Saijo Y, Kikuchi T, Gomi K, Suzuki T, Maemondo M, et al. Pharmacokinetic analysis of combination chemotherapy with carboplatin and etoposide in small-cell lung cancer patients undergoing hemodialysis. Ann Oncol. 2004;15(1):51–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Li YF, Fu S, Hu W, Liu JH, Finkel KW, Gershenson DM, et al. Systemic anticancer therapy in gynecological cancer patients with renal dysfunction. Int J Gynecol Cancer. 2007;17(4):739–63. doi:10.1111/j.1525-1438.2007.00847.x.PubMedCrossRefGoogle Scholar
  16. 16.
    Suzuki S, Koide M, Sakamoto S, Matsuo T. Pharmacokinetics of carboplatin and etoposide in a haemodialysis patient with Merkel-cell carcinoma. Nephrol Dial Transpl. 1997;12(1):137–40.CrossRefGoogle Scholar
  17. 17.
    Heijns JB, van der Burg ME, van Gelder T, Fieren MW, de Bruijn P, van der Gaast A, et al. Continuous ambulatory peritoneal dialysis: pharmacokinetics and clinical outcome of paclitaxel and carboplatin treatment. Cancer Chemother Pharmacol. 2008;62(5):841–7. doi:10.1007/s00280-007-0671-9.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Yoshida H, Sumi T, Abe K, Ishiko O. Pharmacokinetics of paclitaxel and carboplatin in a hemodialysis patient with advanced ovarian cancer. Eur J Gynaecol Oncol. 2009;30(5):583–5.PubMedGoogle Scholar
  19. 19.
    Chatelut E, Rostaing L, Gualano V, Vissac T, De Forni M, Ton-That H, et al. Pharmacokinetics of carboplatin in a patient suffering from advanced ovarian carcinoma with hemodialysis-dependent renal insufficiency. Nephron. 1994;66(2):157–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Gouyette A, Lemoine R, Adhemar JP, Kleinknecht D, Man NK, Droz JP, et al. Kinetics of cisplatin in an anuric patient undergoing hemofiltration dialysis. Cancer Treat Rep. 1981;65(7–8):665–8.PubMedGoogle Scholar
  21. 21.
    Hofmann G, Bauernhofer T, Krippl P, Lang-Loidolt D, Horn S, Goessler W, et al. Plasmapheresis reverses all side-effects of a cisplatin overdose–a case report and treatment recommendation. BMC Cancer. 2006;6:1. doi:10.1186/1471-2407-6-1.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Motzer RJ, Niedzwiecki D, Isaacs M, Menendez-Botet C, Tong WP, Flombaum C, et al. Carboplatin-based chemotherapy with pharmacokinetic analysis for patients with hemodialysis-dependent renal insufficiency. Cancer Chemother Pharmacol. 1990;27(3):234–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Takezawa K, Okamoto I, Fukuoka M, Nakagawa K. Pharmacokinetic analysis of carboplatin and etoposide in a small cell lung cancer patient undergoing hemodialysis. J Thorac Oncol. 2008;3(9):1073–5. doi:10.1097/JTO.0b013e318183af89.PubMedCrossRefGoogle Scholar
  24. 24.
    Fong MK, Fetterly GJ Jr, McDougald LJ, Iyer RV. Carboplatin pharmacokinetics in a patient receiving hemodialysis. Pharmacotherapy. 2013. doi:10.1002/phar.1354.PubMedGoogle Scholar
  25. 25.
    Oguri T, Shimokata T, Inada M, Ito I, Ando Y, Sasaki Y, et al. Pharmacokinetic analysis of carboplatin in patients with cancer who are undergoing hemodialysis. Cancer Chemother Pharmacol. 2010;66(4):813–7. doi:10.1007/s00280-010-1366-1.PubMedCrossRefGoogle Scholar
  26. 26.
    Kodama J, Sasaki A, Masahiro S, Seki N, Kusumoto T, Nakamura K, et al. Pharmacokinetics of combination chemotherapy with paclitaxel and carboplatin in a patient with advanced epithelial ovarian cancer undergoing hemodialysis. Oncology Lett. 2010;1(3):511–3. doi:10.3892/ol_00000090.CrossRefGoogle Scholar
  27. 27.
    Watanabe M, Aoki Y, Tomita M, Sato T, Takaki Y, Kato N, et al. Paclitaxel and carboplatin combination chemotherapy in a hemodialysis patient with advanced ovarian cancer. Gynecol Oncol. 2002;84(2):335–8. doi:10.1006/gyno.2001.6527.PubMedCrossRefGoogle Scholar
  28. 28.
    Hiraike M, Hiraki Y, Misumi N, Hanada K, Tsuji Y, Kamimura H, et al. Pharmacokinetics of carboplatin in a hemodialysis patient with small-cell lung cancer. Cancer Chemother Pharmacol. 2012;69(3):845–8. doi:10.1007/s00280-011-1802-x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Achuta K. Guddati
    • 1
  • Parijat S. Joy
    • 2
  • Creticus P. Marak
    • 3
  1. 1.Department of Internal Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Internal Medicine, University of Iowa Hospitals and ClinicsUniversity of IowaIowaUSA
  3. 3.Division of Pulmonary Medicine, Department of MedicineTahlequah City HospitalTahlequahUSA

Personalised recommendations