Roberts Eve, Mogg Jasper A W, Barnfield Mark, Veal Gareth J
Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
Department of Medical Physics and Engineering, St. James's University Hospital, Leeds, UK.
Pediatr Hematol Oncol. 2020 Apr;37(3):235-244. doi: 10.1080/08880018.2020.1713939. Epub 2020 Jan 16.
Renal function-based carboplatin dosing is a well-accepted practice in pediatric oncology. However, the accuracy of this approach is only as precise as the method of kidney function measurement, most commonly involving determination of glomerular filtration rate (GFR). Recent work by the Children's Oncology Group has raised concerns over nuclear medicine-based methodologies used to calculate GFR across US clinical centers. Current practices of GFR measurement, methods used to calculate carboplatin dosage and the utility of therapeutic drug monitoring were investigated in 21 UK primary pediatric oncology treatment centers through a questionnaire-based study. Information obtained was compared to results previously published in 2008 following a similar survey. In relation to GFR measurement, the main changes observed were a shift toward a greater number of samples being taken following tracer administration and an increase in number of centers using the Brochner-Mortensen correction factor. In relation to the use of renal function assessment data to inform dosing, EDTA elimination half-life in conjunction with body weight was used to calculate carboplatin dose in 18/21 (86%) centers, with uncorrected GFR and body weight utilized in 9/21 (43%) centers. A total of 14/21 (67%) centers utilize therapeutic drug monitoring approaches to carboplatin treatment in defined patient groups including neonates and infants. Results suggest that while GFR measurement across UK centers is relatively consistent, some uncertainties remain. In addition, for patient sub-populations where there are concerns over the potential for marked inter-patient variability in carboplatin exposures, adaptive dosing approaches are now well established.
基于肾功能的卡铂给药在儿科肿瘤学中是一种广泛接受的做法。然而，这种方法的准确性仅取决于肾功能测量方法的精确程度，最常见的是涉及肾小球滤过率（GFR）的测定。儿童肿瘤学组最近的工作引发了对美国各临床中心用于计算GFR的核医学方法的担忧。通过一项基于问卷的研究，对英国21个主要儿科肿瘤治疗中心的GFR测量现行做法、用于计算卡铂剂量的方法以及治疗药物监测的效用进行了调查。将获得的信息与2008年在类似调查后发表的结果进行了比较。关于GFR测量，观察到的主要变化是给药后采集的样本数量增加，以及使用布罗克纳 - 莫特森校正因子的中心数量增加。关于使用肾功能评估数据来指导给药，18/21（86%）的中心使用EDTA消除半衰期结合体重来计算卡铂剂量，9/21（43%）的中心使用未校正的GFR和体重。共有14/21（67%）的中心在包括新生儿和婴儿在内的特定患者群体中采用治疗药物监测方法进行卡铂治疗。结果表明，虽然英国各中心的GFR测量相对一致，但仍存在一些不确定性。此外，对于担心卡铂暴露存在显著患者间变异性的患者亚群，适应性给药方法现已确立。
