The Cockcroft-Gault equation normally uses the total body weight, but this equation also uses the Ideal body weight in the advanced version of the calculations. Fourth, calculation of the observed carboplatin AUC was based on the publication by Ekhart et al. So, carboplatin dosage is calculated using individual patient's renal function and AUC Because carboplatin dosing method is different from other chemotherapeutic agents dosing methods, evaluation of accuracy of dosage calculation and pharmacist's dosage check may be nec- essary. The. The doubletcombination regimens included paclitaxel (N = 8), gemcitabine (N = 3), pemetrexed (N = 2), and etoposide (N = 1). We need to find the BSA of the patient by the following formula: BSA (m) = SQRT{ [ height (cm) x weight (kg)] / 3600 }. Overestimation may result in divergent carboplatin dosages that correlate with dose-limiting thrombocytopenia, treatment delays, and dose reductions. Consider we want to find the GFR of a 50-year-old man whose weight is 78 KG and has a Serum Creatinine of 1.2(mg/dL). Carboplatin dosage relies on glomerular filtration rate (GFR) and area under the curve (AUC). Add this calculator to your site and lets users to perform easy calculations. A retrospective analysis was conducted using data from patients who received carboplatin therapy during the period between January 2008 and January 2009. Dosage and Calculations Practice Tests are some of the most commonly-searched practice exams for both student nurses and nurses wanting to take licensure and certification exams. Dose (mg) = target AUC (mg/ml x min) x (GFR ml/min +25) Measured GFR (e.g. Gender. The skin color may also change during the chemotherapy. The main reason for that is to various levels of immunity in male and female bodies, Carboplatin Clearance for Male=(0,134xweight)+(218xweightx(1-0.00457xage)/serum creat. Besides Classification Accuracy, other related popular model performance measures are sensitivity, specificity, precision, recall, and auc-roc curve. Some patients skin color may turn pale due to the reduction of red blood cells in the body. Once you have found the GFR, we can implement the Calvert formula for optimal carboplatin dosage for patients. It is calculated by (2*AUC - 1). Carboplatin AUC Dose for Female Solution STEP 0: Pre-Calculation Summary Formula Used Carboplatin AUC Dose for Female (mg) = Target AUC* (GFR for female (mL/min)+25) Carbo Dose = AUC* (GFR+25) This formula uses 3 Variables Variables Used Estimations of GFR are frequently used in clinical practice, however, several important points should be reviewed (see below). Ekhart C, Rodenhuis S, Schellens JH, et al. Our results demonstrate that physician prescribers utilized the Cockcroft-Gault equation to estimate GFR in all patients. Future considerations include designing a prospective study evaluating body weight descriptors (ideal vs adjusted) to estimate GFR for use in the Calvert formula incorporating measured carboplatin AUCs compared with target AUCs to identify dose divergence and subsequent adverse clinical events in this population. The most relevant pharmacokinetic parameter for drug exposure is the area under the curve (AUC) of plasma concentration x time following a single dose. Carboplatin is excreted almost exclusively by the kidneys. DICP. Actual body weight was applied to the SCr-based formula in 19 patients (95%). Carboplatin has been approved by the US Food and Drug Administration for the treatment of ovarian cancer and has been used off-label for the treatment of many solid tumors, including lung, head and neck, endometrial, breast, and cervical cancers.1 As a nonclassical alkylating agent, carboplatin acts by covalently binding to DNA, thereby interfering with the crosslinking and synthesis of DNA and cell replication. A study by Herrington and colleagues demonstrated that the optimal weight for overweight and obese patients in SCr based formulas for use in the Calvert formula was adjusted body weight.3 The use of actual body weight in overweight or obese patients resulted in a carboplatin AUC that was 30% to 40% higher than the predicted or targeted carboplatin AUC.3. Accessed August 19, 2011. The maximum allowed doses of carboplatin are: AUC 6 = 900 mg . Duffull SB, Robinson BA. Drs Nightingale, Trovato, Lee, and Thompson have reported no actual or potential conflicts of interest. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. We identified the serum creatininebased formula utilized, the body weight descriptor applied to the glomerular filtration rate formula, and whether a maximal/capped creatinine clearance rate was determined. AUC : Area under curve (AUC) is also known as c-statistics. Drug Calculators. Patient data were accessed through electronic medical records. ABW (kg) = ideal body weight + [0.3 x(actual body weight ideal body weight)]. The IBW can be calculated by the, carboplatin dose calculator using creatinine clearance or adjusted body weight(ABW). The Glomeruli are the tiniest of filters in our kidneys specially designed to filter our blood from waste. The secondary objectives were to identify the presence of grade 3 or 4 thrombocytopenia (25.0-49.9 10e9/L or <25 10e9/L) according to the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events,7 dose modifications, and treatment delays caused by toxicity. Dose capping, 'dose banding' and dose reductions can all lead to an AUC that is lower than the intended target. 2. The GFR estimates how much blood passes through the Glomeruli per minute. The chemotherapy combination regimens that each patient received were not well balanced, thus the addition of other cytotoxic chemotherapy agents, such as paclitaxel, increases the risk and severity of myelosuppression when compared with monotherapy. Acute renal failure (letter). CALVERT FORMULA FOR CARBOPLATIN DOSING: J Clin Oncol. The GFR values usually decrease with the passage of age. Fill in the calculator/tool with your values and/or your answer choices and press Calculate. 2. Calvert AH, Newell DR, Gumbrell LA, et al. The GFR used to calculate the AUC dosing should not exceed 125ml/min. Physician prescribers used the Cockcroft-Gault formula to estimate GFR for use in the Calvert formula in 100% of the patients (N = 20). The free online Carboplatin calculator estimates your Carboplatin dosage(mg) by using the Calvert formula. There are some limitations to our investigation. Clin Pharmacokinet. Common Terminology Criteria for Adverse Events, v3.0S. Mean body weight was applied to the SCr-based formula in 1 patient. Carboplatin is a crystalline powder with the molecular formula of C 6 H 12 N 2 0 4 Pt and a molecular weight of 371.25. How easy was it to use our calculator? The last piece (t 1 - t 2) is the duration of time. . The carboplatin AUC dose calculation does involve your actual body weight and its comparison with the ideal body weight. An electronic tool cannot assess the clinical picture and patient-specific factors. The Calvert formula was used to calculate carboplatin dose, with the estimated GFR being obtained from Cockcroft-Gault equation, CKD-EPI equation, and the Janowitz et al.'s equation. Srensen BT, Strmgren A, Jakobsen P, Jakobsen A. Dose-toxicity relationship of carboplatin in combination with cyclophosphamide in ovarian cancer patients. You may feel redness on your face due to chemotherapy. Prescribers utilized the Cockcroft-Gault formula to estimate glomerular filtration rate in 100% of the participants (N = 20). The carbo calculator can be used to find Carboplatin dose (mg) for patients. Follow-up for information letter regarding AUC-based dosing of carboplatin. The demographics and baseline laboratory values of the patients are described in Table 2. Levey AS, Bosch JP, Lewis JB, et al. the 1980s, carboplatin was primarily dosed using the body surface area (BSA) method. This information was gathered from a preprinted chemotherapy order form that included calculations for estimated renal function and the body weight descriptor applied. Objective: The primary objective of this study was to evaluate physician prescribing practices with the Calvert formula in overweight and obese patients. Did you face any problem, tell us! Furthermore, in overweight and obese populations, body weight (actual body weight vs ideal body weight) applied to an SCr-based formula may overestimate GFR. Chatelut E, Canal P, Brunner V, et al. Seventy percent of the patients (N = 14) were treated with doublet-combination chemotherapy, and the remaining 30% of patients (N = 6) received a triplecombination chemotherapy regimen. Carboplatin clearance IS dependent on patient's renal function. This study was presented as a poster at the 5th Annual Meeting of the Hematology Oncology Pharmacy Association; June 2009; Miami, FL, Advances in Dual Immunotherapy Cancer Treatments, James A. Trovato, PharmD, MBA, BCOP, FASHP, Impact of Pharmacist Telephone Follow-Up on Chemotherapy-Induced Nausea and Vomiting, Evaluating Institutional Safety Standards Related to Continuing Oral Antineoplastic Medication Use During Hospitalization, Time to First Palbociclib Prescription Dispense at Mayo Clinic: Comparing a Health-System Specialty Pharmacy with External Specialty Pharmacies, Comparing the Impact of Abiraterone and Enzalutamide Sequencing on Progression-Free Survival in Veterans with Metastatic Castration-Resistant Prostate Cancer, The Link Between Hypoalbuminemia and Oral Tyrosine Kinase Inhibitor Adverse Events in Adults with Malignant Solid Tumors, Safety and Efficacy of Intravenous Bisphosphonates for the Treatment of Hypercalcemia in Patients with Cancer and Baseline Renal Dysfunction, Comparing Single-Center Outcomes Between Reference and Biosimilar Granulocyte Colony-Stimulating Factor Drugs Used for Autologous Stem-Cell Mobilization, Evaluation of Clinical Pharmacy Services for Phase 1 Clinical Trials, Reduced Starting Dose of Tyrosine Kinase Inhibitors in Patients with Metastatic Renal-Cell Carcinoma, Hepatitis B Virus Infection Monitoring in Patients with Lymphoma Receiving Anti-CD20 Monoclonal Antibodies, Low body weight: body mass index (BMI) <18.5 kg/m, Normal/ideal body weight: BMI 18.5-24.9 kg/m. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf. Among the AUC-5/6 patients, the CG equation resulted in a broad range of eGFR values varying from approximately 30 to 150 ml/min for the first four carboplatin cycles (Fig. Developed by : Now that you've calculated the correct BSA and clearance, pick a drug. When we are doing Chemotherapy on a patient, it is necessary to know what Carboplatin dosage is required. ), Carboplatin clearance for Female = (0,134xweight)+0.686x(218xweightx(1-0.00457xage)/serum cr?t.). In practice this means that for every point we wish to classify follow this procedure to attain C's performance: Generate a random number between 0 and 1. Be sure to check the link to the "new version," which includes the CKD-EPI equation (corrected for BSA) as an additional clearance equation. All content and tools are for educational use only, are not meant to be a substitute for professional advice and should not be used for medical diagnosis and/or medical treatment. To sign up for our newsletter or print publications, please enter your contact information below. By using this site you acknowledge that you have read, understand, and agree to be bound by our terms of use and privacy policy. To calculate carboplatin dose, the modified Calvert formula was used: dose (mg/m 2) = target AUC (raw GFR (mL/min) + 15 body surface area (BSA) (m 2)). Data collection included demographic information, pretreatment and posttreatment complete blood count and nadir, concurrent cytotoxic chemotherapy, and any supporting documentation confirming treatment delays and dose reductions. NIH Publication No 98- 4083. The secondary objective was to identify presence of grade 3 or 4 thrombocytopenia, per the National Cancer Institute Common Toxicity Criteria for Adverse Events, treatment delays, and dose reductions. Confusion Matrix & Classification Accuracy Calculation. This process is called Scoring. Fifty percent of the patients were obese, and the mean BMI was 32.059 kg/m2. Carboplatin is an antineoplastic agent that interferes with DNA replication and cell division. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. IBW (males) = 50 kg + 2.3 x (height [inches] 60), IBW (females) = 45.5 kg + 2.3 x (height [inches] 60). Glomerular Filtration Rate(GFR) displayed. Demographics of the patients included in the study were collected. These initiatives are limited, because they do not address the body weight that should be applied to the Cockcroft-Gault equation in special populations of overweight and obese patients. The results you receive from this tool are for informational purposes only and should not be Thadhani R, Pascual M, Bonventre JV. If two or more of the three patients experienced a Grade 3-4 AE during the first . Creating an account is free and takes less than 1 minute. Steps on how to print your input & results: 1. This dosing calculator adjusts for renal dysfunction by using the Cockcroft-Gault formula to estimate GFR. Carboplatin is a chemotherapy drug commonly used to treat ovarian cancer. Most patients had a primary diagnosis of nonsmallcell lung cancer, followed by malignancy of the head and neck. Prescribers applied the laboratory-derived SCr to all SCr-based formulas. 5) AUC-based carboplatin dosing is more accurate than dosing according to BSA. Existing data suggest a strong correlation between carboplatin AUC and dose-limiting myelosuppression, specifically thrombocytopenia.16-18 The incidence of thrombocytopenia in our study population was higher compared with those of standard populations. Patients were excluded if baseline laboratory values were not available. CrCl for female = [ (140 - age) x Weight in kilograms x 1.04] / (Serum Creatinine in mol/L) The ideal body weight by Devine's formula: Male = 50 kg + (2.3 x (Height in inches - 60)) Female = 45.5 kg + (2.3 x (Height in inches - 60)) The ideal weight result is converted in both kg and lbs for convenience, where (1 kg = 2.20462262 lbs). Devine BJ. Male = 50 kg + (2.3 * (Height in inches - 60)) Female = 45.5 kg + (2.3 * (Height in inches - 60)) Carboplatin dose based on the Calvert formula is: Dosage = Target AUC x (GFR + 25) Carboplatin and target AUC The carboplatin dosage value is calculated by taking into account the target area concentration versus time curve and estimated GFR. Where: AUC=Target area under concentration curve against the time curve in mg/mL. AUC values of 4 to 6 (for previously treated patients) and 6 to 8 (for treatment nave patients) will give an acceptable hematological toxicity. This method is costly and may be clinically impractical; therefore, GFR is usually estimated from SCr-based formulas.10-12. For measuring the exact dosage of the Carboplatin, we use the Calvert formula to measure the kidney functionality: Total Dose (mg) = (target AUC) x (GFR + 25) The dose is administered by the injection via a vein, and after around 24 hours, 70 % of the drug is excreted into the urine. A universal formula based on cystatin C to perform individual dosing of carboplatin in normal weight, underweight, and obese patients. Approximately 65% to 70% of the total platinum dose is eliminated as intact carboplatin in the urine during the first 12 to 16 hours after administration.1. . Calculation for carboplatin dose (Calvert Equation): Sherif Abdou, Pharm.D, Northwestern Memorial, SCr defaults to 0.7 IF it is lower than 0.7, Adjusted body weight will be used for BMI 25, Any electronic tool, including those found on OncPharm.com, are not substitutes for clinical experience and expertise. From the source of Wikipedia: Carboplatin, Medical uses, From the source of medscape.com: Dosing & Uses,Advanced Ovarian Carcinoma. To be able to investigate this further we defined the variable 'delivered AUC' (dAUC) for carboplatin as: the delivered dose at cycle 1 full dose (according to an uncapped/'unbanded' eGFR from the CG formula using IDMS SCr and ABW) 6. Sherif Abdou, Pharm.D, Northwestern Memorial Estimation of GFR may be performed using the Wright formula or the Cockcroft and Gault formula to measure creatinine clearance. Dr Nightingale is Assistant Professor, Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA; Dr Trovato is Associate Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore; Dr Lee is Investigational Drug Specialist, Supervisor, Investigational Drug Service Pharmacy, Department of Pharmacy, University of Maryland Medical Center, Baltimore; and Dr Thompson is Investigational Drug Specialist, Investigational Drug Service Pharmacy, Department of Pharmacy, University of Maryland Medical Center, Baltimore. Hence, patient characteristics (such as exposure to prior therapy and age) and data aquisition (such as blood-sampling intervals and methods of measuring AUC and calculating GFR) need to be in concordance to ensure the correctness of the basic reasoning that any dose of carboplatin administered to a patient can be estimated in terms of his or . NCCN Chemotherapy Order Templates Appendix B: Carboplatin Dosing , who did not report bias or imprecision of their method, and visual inspection of the goodness of fit of the final model. Specifically, we identified the SCrbased formula used by the physician prescriber to estimate the GFR and body weight (ie, actual, ideal, adjusted) applied to the SCr-based formula, and whether a maximal/capped creatinine clearance (CrCl) rate was determined at the discretion of the prescriber. We defined treatment delays as 7 days from the planned day of carboplatin administration. Conclusion: The use of actual body weight in the Cockcroft-Gault equation to estimate glomerular filtration rate in the Calvert formula was associated with a high percentage of adverse clinical events. The Jelliffe equation is used by most gynecologic oncology group protocols, and gynecologic malignancies did not comprise our study population, which explains why the equation may not have been used. It can be 60/40 or 80/20. Prescribers did not apply an adjusted SCr value to account for the influence of muscle mass on creatinine concentrations in the elderly. Ekhart and colleagues assessed the utility of alternative weight descriptors in the Cockcroft-Gault equation to more accurately predict carboplatin clearance in special body weight populations.5 The results demonstrated that adjusted body weight was the best weight descriptor in overweight and obese patients. carboplatin dosage. Patient gender to be used in the Cockcroft Gault equation and in Devines formula; Patient age in years, to be used in the Cockcroft Gault equation; Patient weight can be input in either lbs or kg; Patient height can be specified in either ft and in or cm; Serum creatinine measured in mg/dL or mol/L; Target AUC expected values range between 4 and 8 mg/mL/min; The Cockcroft and Gault equations when serum creatinine is in mg/dL: CrCl for male = [(140 - age) x Weight in kilograms] / (Serum Creatinine in mg/dL x 72), CrCl for female = [(140 - age) x Weight in kilograms x 0.85] / (Serum Creatinine in mg/dL x 72). Consider a male patient having an age of 22 years, weight 67 Kg,serum creatinine level equal to 5 mg/dL. Carboplatin dose (mg) = AUCx (GFR + 25) Carboplatin dose (mg) = 7 x (81.25 + 25) Carboplatin dose (mg) = 7 x 106.25 We do consider the actual body weight and compare it to the ideal body weight to find the chemo dosage. For 70-year-old people, the normal range of GFR is around 60 mL/min/1.73 m2. Accessed August 19, 2011. The influence of the modality of prescription of carboplatin according to body surface area or to carboplatin clearance related to the renal function was evaluated according to the Calvert AUC-based equation; glomeruler filtration rate (GFR) was evaluated according to the Cockroft formula from the serum creatinine level that was measured before each new cycle of chemotherapy; and carboplatin . Target AUC values differ depending on the status of the patient: For patients already treated, target AUC should be around 4 7 mg/mL/min; For patients without previous treatment target AUC should be around 6 8 mg/mL/min. Carboplatin plasma clearance was linearly related to GFR (r = 0.85, P less than .00001) and rearrangements of the equation describing the correlation gave the dosage formula dose (mg) = target area . Kidney function was stable for all patients. National Institutes of Health, National Cancer Institute. If the number is greater than k apply classifier A. Please note that dose is provided in mg not mg/m 2. We always struggled to serve you with the best online calculations, thus, there's a humble request to either disable the AD blocker or go with premium plans to use the AD-Free version for calculators. This carboplatin dosing calculator uses the Calvert method to calculate the total carboplatin dose needed to achieve a given AUC (area under the free carboplatin plasma concentration versus time curve) while taking into account renal function. Male: (98 (0.8 x (age 20)) / (SCR in mg/dl)) x Patients BSA/1.73 M2. The carboplatin calculator helps determine the correct dosage for each patient. How to Calculate priceeight Density (Step by Step): Factors that Determine priceeight Classification: Are mentioned priceeight Classes verified by the officials? Shord and colleagues conducted a retrospective analysis to determine the absolute difference between the dose of carboplatin administered using traditional SCr-based formulas to estimate GFR versus the dose calculated based on the MDRD equation.13 Results showed a carboplatin AUC dose divergence in 48% of the patients, yet the frequency of neutropenia, thrombocytopenia, and dose modifications were similar between the 2 groups using either the SCr-based formulas or the MDRD equation to estimate GFR value. J Clin Oncol. Alternative formula Adjusted body weight (ABW): We can also use the Alternative formula Adjusted body weight (ABW) to get more accurate results. This was a retrospective study design, and we were not able to control for the heterogeneity that comprised our small study population.There was also inconsistency with regard to the number of carboplatin treatment cycles that patients received in relation to documented dose reductions or treatment delays. Calvert AH, Newell DR, Gumbrell LA, et al. The Calvert formula is the preferred method to calculate the dose for a given target AUC.2 Serum creatinine (SCr)-based formulas are used to estimate GFR when calculating carboplatin dosage with the Calvert formula. *Actual lab serum creatinine value with a minimum of 0.7 mg/dl. The calculator will readily estimate carboplatin dosage in milligrams by considering your cretanine and targetted AUC value. For a given time interval (t 1 - t 2 ), the AUC can be calculated as follows: In essence the first two terms calculate the average concentration over the time interval. Please note that dose is provided in mg not mg/m 2. Carboplatin Calculator or Carboplatin AUC Calculator. In our study, applying actual body weight to estimate GFR for use in the Calvert formula did correlate with a high percentage of clinical events, including grade 3 or 4 thrombocytopenia and dose reductions secondary to toxicity. A maximum/capped CrCl rate of 125 mL/min was used for 2 patients (10%). Calculation steps for carboplatin d osage are available o n page 2 . = AUC (mg/ml x min) x carboplatin clearance (ml/min) AUC = Area Under the Curve; carboplatin clearance for Male = (0,134xweight)+(218xweightx(1-0.00457xage)/serum creat.) There are scarce data to guide decision-making regarding the influential variables within the Calvert formula (Table 1). Use the Cockcroft and Gault method to calculate estimated creatinine clearance: CrCl = (140 - age) x wt. The Carboplatin calculator determines the therapy AUC dose based on the Cockcroft Gault equation and on target AUC. The triple-combination chemotherapy regimens included paclitaxel (N = 5) and gemcitabine (N = 1) to monoclonal antibodies such as bevacizumab, cetuximab, and an investigational agent. We normally utilize the Cockcroft-Gault equation for finding the carboplatin dosage. Alberts DS, Dorr RT. 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