Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, 50 Fruit Street, Boston, MA, USA,
Med Oncol. 2014 Mar;31(3):848. doi: 10.1007/s12032-014-0848-0. Epub 2014 Jan 23.
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.
卡铂是最常被开的细胞毒性药物之一，广泛用于多种恶性肿瘤的治疗方案中。卡铂的治疗效果已被发现与曲线下面积（AUC）相关。Calvert 公式被广泛用于确定固定 AUC 和肾小球滤过率（GFR）下的卡铂剂量。该公式也用于接受血液透析的终末期肾病患者，假设 GFR 为零。这适用于在卡铂输注后 12-18 小时内接受血液透析的患者。在最初的 24 小时后，大部分与蛋白质结合的卡铂不易被透析，因此尽管反复进行血液透析，仍会继续留在血液中。我们推导出一个校正因子来计算此类患者的最终 AUC。使用该校正因子进行的分析表明，接受调整剂量但血液透析延迟超过输注后 24 小时的患者，AUC 可增加八倍。这里提出的校正因子也可用于计算可能延迟血液透析的患者的预先剂量调整。它还有助于预测 AUC 并估计此类患者的毒性。
