Top Left Logo
Cance Care for Health Professionals Healthy People, Healthy Communities
Skip Navigation Links
Home
Careers
Tenders
Give
For Health Professionals
Contact Us

Spacer Spacer Spacer Spacer
Index      Small Text Medium Text Large Text  


Section 1: Ordering Chemotherapy 
Section 2: Pharmacy 
Section 3: Nursing 
Administration of New Agents 
Appendix 1  

 

Appendix 1: Guideline for the Dosing and Administration of Carboplatin (Paraplatin®) by the Provincial Systemic Therapy Program

Overview: 

Carboplatin is a more stable analog of cisplatin and has less nephrotoxicity, neurotoxicity, ototoxicity and emetogenesis.  It is currently indicated for use in the treatment of ovarian cancer.  It is also used in the treatment of lung cancer, head and neck cancer, endometrial cancer, esophageal cancer, bladder cancer, breast cancer, cervical cancer, CNS tumors, germ cell tumors, osteogenic sarcoma, and high-dose therapy with stem cell/bone marrow support.  Myelosuppression, primarily thrombocytopenia and leukopenia, is the major dose-limiting adverse effect. 
 

The dosing of carboplatin is unique in that it is calculated according to a targeted area under the plasma concentration versus time curve (AUC) rather than according to body surface area (BSA).  The formula used to calculate carboplatin doses (Calvert formula) has several variables that may lead to significantly different doses.  This document is intended to clarify the use of the Calvert formula and, thereby, enhance patient safety and decrease the likelihood of calculation-related errors.

Guideline:

1.  Carboplatin dose must be calculated by the prescriber according to the guideline outlined below.

2.  Dose of carboplatin must be calculated using the Calvert AUC formula:

Dose (mg) = Target AUC x (GFR + 25)

3.  Glomerular Filtration Rate (GFR) is estimated according to the Cockroft-Gault formula: 

GFR (mL/min) = (140 – age) x weight (kg) x N
                                      SCr (µmol/L)

N = 1.04 for females; 1.23 for male
SCr - serum creatinine concentration
Weight - Ideal Body Weight (IBW), in most instances

4.  Ideal Body Weight is to be calculated using the following formulae:   

IBW (males) = 50 + 2.3 x [height (inches) – 60]
IBW (females) = 45.5 + 2.3 x [height (inches) – 60]
 
5.  The lesser of the actual body weight (ABW) and the ideal body weight (IBW) shall be used in the Cockroft-Gault formula unless the patient is obese.  Obesity is defined as Actual Body Weight (ABW) greater than 130% of the Ideal Body Weight (IBW).

6.  In the case of an obese patient, an Adjusted Body Weight (AdBW) is to be used according to the following formula:          

AdBW = IBW + 0.4 x (ABW – IBW)

 
7.  Serum creatinine must be measured within 2 weeks prior to the intended treatment date if this is the first dose of drug.  For subsequent treatments and if patient is on active therapy, the serum creatinine must be measured within 48 hours of treatment.

8.  Any discrepancies are to be confirmed with the prescriber.

9.  Clinical oncology pharmacists of the Dr. H. Bliss Murphy Cancer Center or the inpatient oncology ward are to be contacted if there are any questions or concerns regarding the use of this guideline.

10.  All staff responsible for calculating and/or verifying doses of carboplatin must attend an educational session provided by the clinical pharmacists of the Dr. H. Bliss Murphy Cancer Center or the inpatient oncology ward.

 
References:
  • Paraplatin®.  Product monograph. 1998
  • Cockcroft D, Gault M. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16:31-41
  • Calvert AH, Newell DR, Gumbrell LA et al: Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 1989; 7:1748-1756
  • Hutson P et al. Carboplatin Dosing in Obese Patients. Proc Am Soc Clin Oncol 2000, abstract 725
  • Herrington, J D et al. Prospective analysis of carboplatin AUC dosing in patients with a BMI > 27 or cachexia.  Proc Am Soc Clin Oncol 22: page 150, 2003 (abstr 599).
  • Thompson Micromedex Healthcare Series Online.
    Back |  CONTENTS  |

    spacer


    Updated Dec 4, 2013