Pharmacokinetics of Carboplatin in a One-Year-Old Anuric Boy Undergoing Hemodialysis and a Review of the Literature.
There have been few reports of carboplatin-based chemotherapy for anuric infants. As we had a chance to treat a one-year-old anuric hepatoblastoma patient with carboplatin, we performed a pharmacokinetic analysis and examined the optimal treatment strategy. A one-year-old anuric boy under peritoneal dialysis was diagnosed with hepatoblastoma. Surgical resection was performed, and administration of carboplatin was scheduled postoperatively aiming at 5 mg·min/mL of the area under the curve from the time of dosing to the time of the last observation (AUC(0-t)). We set the initial dose at 50 mg, higher than that calculated by the Calvert formula (34 mg); the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h; and the hemodialysis duration at 24 h. The actual AUC0-t was 3.05 mg·min/mL because the elimination half-lives before and during hemodialysis were shorter than expected. The AUC(0-t) after the second dose (100 mg) and the third dose (80 mg) were 7.00 and 4.68 mg·min/mL, respectively. The Calvert formula is not suitable for hemodialysis patients because removal of platinum by hemodialysis is not taken into account. It appears that extrarenal clearance in anuric infants is different from that in adults. We obtained an optimal AUC(0-t) using a dose of 80 mg (200 mg/m(2)), setting the time from the end of carboplatin infusion to the initiation of hemodialysis at 2 h, and performing 8-h hemodialysis. Further accumulation of the pharmacokinetic data of carboplatin is necessary for anuric children.
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Koichi
K
Kamei
Division for Clinical Trials, Department of Development Strategy, Center for Social and Clinical Research, National Research Institute for Child Health and Development, National Center for Child Health and Development, Tokyo, Japan.
Mayumi
M
Sako
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Tomoaki
T
Ishikawa
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Mai
M
Sato
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Masao
M
Ogura
Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
Teruaki
T
Uno
Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
Chikako
C
Kiyotani
Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
Tetsuya
T
Mori
Department of Surgery, National Center for Child Health and Development, Tokyo, Japan.
Hideaki
H
Tanaka
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Shuichi
S
Ito
Division for Clinical Trials, Department of Development Strategy, Center for Social and Clinical Research, National Research Institute for Child Health and Development, National Center for Child Health and Development, Tokyo, Japan.
Hidefumi
H
Nakamura
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001002:Anuria / Q000150:complications / Q000378:metabolism*; D016190:Carboplatin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006207:Half-Life; D018197:Hepatoblastoma / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D008113:Liver Neoplasms / Q000188:drug therapy / Q000601:surgery; D008297:Male; D010530:Peritoneal Dialysis; D006435:Renal Dialysis
D000970:Antineoplastic Agents; D016190:Carboplatin
Carboplatin; Hemodialysis; Hepatoblastoma; Infant; Pharmacokinetic analysis