Treatment of advanced ovarian carcinoma with carboplatin and paclitaxel in a patient with renal failure

Platinum-based chemotherapy is the standard treatment for ovarian cancer. Since carboplatin elimination occurs largely through the kidneys, its use in patients with hemodialysis-dependent renal failure requires dose adjustments befitting the level of renal function. We employed the AUC (area under the concentration-time curve)- directed dosing strategy (the Calvert formula) to determine the carboplatin dose appropriate for an ovarian cancer patient with renal failure. Our approach is compared and defended against the empiric and thrombocyte nadir-directed dosing strategies. Since carboplatin clearance follows creatinine clearance, we also provide a review of methods and formulas used to determine creatinine clearance. An accurate method to determine creatinine clearance will enable others to use the AUC-directed dosing strategy to establish the carboplatin dose appropriate for patients with some residual renal function.