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Generation of evidence-based carboplatin dosing guidelines for neonates and infants
Barnett, S. Makin, Guy Tweddle, D. A. Osborne, C. Veal, G. J.
Barnett, S.
Makin, Guy
Tweddle, D. A.
Osborne, C.
Veal, G. J.
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Abstract
Background: To optimally dose childhood cancer patients it is essential that we apply evidence-based dosing approaches. Carboplatin is commonly dosed to achieve a cumulative target exposure (AUC) in children, with target AUC values of 5.2-7.8 mg/ml.min defined. To achieve these exposures patients are dosed at 6.6 mg/kg/day or 4.4 mg/kg for patients <5 kg. The current study uses real world clinical pharmacology data to optimise body weight-based doses to effectively target AUCs of 5.2-7.8 mg/ml.min in infants.
Methods: Carboplatin exposures were determined across 165 treatment cycles in 82 patients ≤10 kg. AUC and clearance values were determined by Bayesian modelling from samples collected on day 1. These parameters were utilised to assess current dosing variability, determine doses required to achieve target AUC values and predict change in AUC using the modified dose.
Results: No significant differences in clearance were identified between patients <5 kg and 5-10 kg. Consequently, for patients <5 kg, 4.4 mg/kg dosing was not sufficient to achieve a target AUC of 5.2 mg/ml.min, with <55% of patients within 25% of this target. Optimised daily doses for patients ≤10 kg were 6 mg/kg and 9 mg/kg for cumulative carboplatin target exposures of 5.2 and 7.8 mg/ml.min, respectively.
Conclusions: Adoption of these evidence-based carboplatin doses in neonates and infants will reduce drug exposure variability and positively impact treatment.
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Date
2023
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Article
Citation
Barnett S, Makin G, Tweddle DA, Osborne C, Veal GJ. Generation of evidence-based carboplatin dosing guidelines for neonates and infants. British journal of cancer. 2023 Oct 10. PubMed PMID: 37816842. Epub 2023/10/11. eng.