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Published Online, 20 October 2009, www.theannals.com, DOI 10.1345/aph.1L446a.
 The Annals of Pharmacotherapy: Vol. 43, No. 11, pp. 1914-1915. DOI 10.1345/aph.1L446a
© 2009 Harvey Whitney Books Company.
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Comment: Evaluation of the Modified Diet in Renal Disease Equation for Calculation of Carboplatin Dose

Mário L de Lemos, PharmD MSc (Oncol)

Provincial Drug Information Coordinator Pharmacy Department British Columbia Cancer Agency 600-750 West Broadway Vancouver, British Columbia, Canada fax 604/708-2024 mdelemos{at}bccancer.bc.ca

Linda Hamata, BSc(Pharm)

Staff Pharmacist Pharmacy Department British Columbia Cancer Agency

James Conklin, BSc(Pharm) ACPR

Staff Pharmacist Pharmacy Department British Columbia Cancer Agency

Published Online, October 20, 2009. www.theannals.com, DOI 10.1345/aph.1L446a

TO THE EDITOR: Shord et al.1 reported similar frequencies of thrombocytopenia, neutropenia, and the need for dosage modifications in their comparison of carboplatin doses based on traditional serum creatinine (SCr)–based equations (ie, Cockcroft-Gault, Jelliffe) versus the Modification of Diet in Renal Disease (MDRD) equation. However, they concluded that the estimated glomerular filtration rate (GFR) and the MDRD equation should not be used to estimate carboplatin doses until more data are available.

We previously found that carboplatin dosing based on the MDRD equation was associated with precision better than and bias similar to that of the Cockcroft-Gault equation, compared with measured GFR.2 More recent studies also support these findings. Poole et al.3 reported no significant deviation from "true" carboplatin dose (based on measured GFR) in similar proportions of patients between the MDRD (58%) and the Cockcroft-Gault equations (63%). Two other studies also reported good correlation in carboplatin dose between the 2 equations (correlation coefficient of 0.73 and 0.88).4,5

The MDRD equation allows for the automatic reporting of estimated GFR as part of renal biochemistry. This may reduce potential calculation errors. Shord et al. showed that any discordance between the 2 equations is unlikely to be clinically significant for the patient with average body size (body surface area ~1.8 m2) and renal function (SCr ~1.0 mg/dL). Therefore, it seems reasonable to use either equation to guide carboplatin dosing if measured GFR is not available, provided that the same estimation method is used during a particular course of treatment. A similar recommendation has been made by the British National Formulary, as well as by expert consensus in Australia and New Zealand.6

Footnotes

Financial disclosure: None reported

References

  1. Shord SS, Bressler LR, Radhakrishnan L, Chen N, Villano JL. Evaluation of the Modified Diet in Renal Disease equation for calculation of carboplatin dose. Ann Pharmacother 2009;43:235-41. Epub 3 Feb 2009. DOI 10.1345/aph.1L446[Abstract/Free Full Text]
  2. de Lemos ML, Hsieh T, Hamata L, et al. Evaluation of predictive formulae for glomerular filtration rate for carboplatin dosing in gynecological malignancies. Gynecol Oncol 2006;103:1063-9. DOI 10.1016/j.ygyno.2006.06.024[CrossRef][Medline]
  3. Poole SG, Dooley MJ, Rischin D. Calculating carboplatin doses using the 4-variable Modification of Diet in Renal Disease (4-v MDRD) estimate of glomerular filtration rate (GFR) in the Calvert formula (abstract 2521). 2007 ASCO Annual Meeting Proceedings. J Clin Oncol 2007;25 (Jun 20 suppl):2521.
  4. Cooper AV, Roques TW. Can MDRD (Modification of Diet in Renal Disease) be used to estimate GFR in patients receiving carboplatin (abstract)? Clin Oncol (R Coll Radiol) 2007;19(3): S27. DOI 10.1016/j.clon.2007.01.349
  5. Barry A, O'Cearbhaill R, Griffin D, Donnellan P, Keane M, Grimes H. Evaluation of carboplatin dosage based on 4-variable modification of diet in renal disease equation. Ir J Med Sci 2009;178:301-7. Epub 11 Nov 2008. DOI 10.1007/s11845-008-0250-z[CrossRef][Medline]
  6. Jones GR, Mathew T, Johnson D, Peake M. Implementation of the routine reporting of eGFR in Australia and New Zealand. Scand J Clin Lab Invest Suppl 2008;241:23-9. DOI 10.1080/00365510802144953[Medline]




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