In DeVIC chemotherapy (dexamethasone, etoposide, ifosfamide, carboplatin), a salvage chemotherapy for non-Hodgkin's lymphoma (NHL), a dosage of CBDCA is determined based on body surface area (BSA). With this dosing method, a dose is calculated without consideration of the renal function. We evaluated the accuracy of this dosing method.Subject and methods
Forty-three cases treated by DeVIC chemotherapy at Fujita Health University Hospital between January 2005 and December 2011 were included in this study. CBDCA was dosed based on BSA (300 mg/m2), and the area under the plasma concentration time curve (AUC) was calculated based on a given dosage using a Calvert formula.Results
In 24 cases with 1.3–1.8 m2 of BSA and 60–120 ml/min of the estimated glomerular filtration rate (eGFR), AUC calculated based on a given dosage was 3.1–5.7 (median 3.9). The data showed that the calculated AUC was within appropriate and safe level as targeted AUC in chemotherapies for solid tumors. Adverse drug reactions (especially thrombopenia) with this AUC level were tolerable. In 14 of the 19 cases with <1.3 m2 of BSA or <60 ml/min of eGFR, there was a great variation in the calculated AUC with the result of 2.8–7.8 (median 4.1). Five cases with over 120 ml/min of eGFR were excluded from the analysis.Discussion
In phaseII studies for NHL, it was demonstrated that there was no difference in a response rate with 200–400 mg/m2 of CBDCA stratified dose. 63% of response rate and 38% of complete remission rate (CR) with a dosage of CBDCA 300 mg/m2 (fixed dose in patients aged younger than 71) were reported in DeVIC clinical study for relapsed/refractory NHL. It is suggested that this CBDCA dosing method based on BSA in DeVIC chemotherapy is appropriate for cases with the general BSA and renal function; however, dose evaluation should be required in cases with lower BSA or moderate/severe renal impairment.