Background. Carboplatin is the most effective drug in retinoblastoma but systemic clearance is variable in young patients. While most regimens use a flat dose, individualized targeting may provide a more adjusted systemic exposure. Patients and Methods. We compared carboplatin doses between two groups of children with retinoblastoma that were treated using a flat dose of 560 mg/m2 or a targeted AUC of 6.5 using a modified Calvert formula. Results. Ninety-eight patients with retinoblastoma received a total of 576 cycles of carboplatin (median 8 cycles). Fifty patients (51%) received a fixed dose per m2, 32 (33%) received a dose based on AUC, 1 patient received fixed dose per kilogram, and in 15 patients a combination AUC and fixed doses was used. The median cumulative carboplatin dose (mg/m2) for patients who received eight cycles using fixed per m2 dosing was 2151.8 (range, 1414.2-2852.0), compared to 1104.1 for nine patients who received eight cycles using Calvert dosing (range, 779.0-1992.7) (P<0.001). For cycles given using AUC, the median percentage of the hypothetical fixed per m2 dose was 70% (range, 48-134%). Younger patients had larger differences. Patients receiving carboplatin based on fixed per m2 dosing were 3.0 times more likely to have a platelet transfusion (95% confidence interval, 1.3-7.3). Conclusions. Carboplatin administration needs to consider the changes in renal function occurring during the first months of life. The use of a targeted AUC provides the most accurate method; however, mg per kg of body weight dosing is a very reliable alternative method.
- Glomerular filtration rate
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health