title: Dosing of carboplatin in a patient with amputated legs: A case report.
abstract: Carboplatin is a platinum derivative that is commonly used in combination chemotherapy for treatment of several malignancies, including small-cell lung carcinoma (SCLC). Because the estimated glomerular filtration rate, and therefore the carboplatin dose, is based on the serum creatinine level, dosing of carboplatin for amputees is a challenge. This case report describes how serum carboplatin levels were used to determine the most suitable carboplatin dose for an amputee. The patient received four cycles of etoposide in combination with carboplatin area under the curve = 5 mg·min/ml, with a dose reduction of 25% and concurrent radiotherapy. The measured area under the curve was found to be 3.41 mg·min/ml, while the target area under the curve was 3.75 mg·min/ml (75% of 5 mg·min/ml). Therefore, for the next cycles, the carboplatin dose was calculated using the Calvert formula. No recurrence of disease was seen within two years after completion of therapy. This case demonstrates that therapeutic drug monitoring can successfully be used to determine the carboplatin dose for an amputee.
authors.affiliation: Department of Pharmacy, Diakonessenhuis, Utrecht, The Netherlands fvgorp@diakhuis.nl.
authors.forename: F
authors.initials: F
authors.lastname: van Gorp
authors.affiliation: Department of Pulmonology, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: M Th M
authors.initials: MT
authors.lastname: van Rens
authors.affiliation: Department of Pharmacy, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Kuck
authors.affiliation: Department of Pharmacy, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Rozemeijer
authors.affiliation: Department of Pharmacy & Pharmacology, Slotervaart Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: A D R
authors.initials: AD
authors.lastname: Huitema
authors.affiliation: Department of Pharmacy, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: E E M
authors.initials: EE
authors.lastname: Brouwers
mesh_terms: D000368:Aged; D000674:Amputees; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000493:pharmacokinetics; D019540:Area Under Curve; D016190:Carboplatin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy; D008297:Male; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000628:therapy
chemical_list: D005047:Etoposide; D016190:Carboplatin
keywords: Carboplatin; amputation; renal function; small-cell lung carcinoma; therapeutic drug monitoring