Influence of Kidney Function Estimation Methods on Carboplatin Dosing and Clinical Outcomes

The use of the Calvert formula for carboplatin dosing is well established. However, controversy persists regarding the choice of kidney function estimation equations, with oncology and nephrology guidelines offering differing recommendations.

This study aimed to compare the actual carboplatin doses administered to patients with those estimated using various kidney function equations, and to assess whether these differences could influence clinical outcomes.

This retrospective chart review included adult patients who received at least 1 dose of carboplatin at our institution between May 2015 and March 2024. Carboplatin doses were estimated using the Calvert formula with different kidney function equations and compared with the actual doses administered.

A total of 360 patients met the inclusion criteria, with a median age of 57 years (46-68), a median weight of 72 kg (61-84), and 248 (68.9%) were female. Significant inter-method variability was observed in the median estimated kidney function and corresponding median carboplatin dosing across equations. Cockcroft-Gault (C-G) using actual body weight (110 mL/min, 677 mg), C-G with adjusted body weight (94 mL/min, 602 mg), 2021 CKD-EPI (chronic kidney disease epidemiology collaboration) (100 mL/min/1.73 m², 649 mg), 2021 CKD-EPI_BSAAdj (101 mL/min, 658 mg), and the Janowitz equation (83 mL/min, 577 mg), P < 0.001. Hematologic toxicity, including febrile neutropenia, was significantly more common in patients dosed using C-G equation with actual body weight compared with adjusted body weight, occurring in 14/20 (70%) versus 5/115 (4.3%), respectively (P < 0.001).

Carboplatin dosing varies significantly depending on the kidney function estimation method used. There is an urgent need for standardized, interdisciplinary dosing guidelines.