{"entity":{"id":"idea-upgrade-carboplatin-gfr-estimate-outcome-study","kind":"idea","name":"Compare carboplatin dosed by BSA-adjusted CKD-EPI eGFR with Cockcroft-Gault on toxicity and response","aka":[],"tldr":"Carboplatin doses depend on an estimate of kidney function. The 2025 international guideline (ADDIKD) recommends a newer estimate (BSA-adjusted CKD-EPI) over the old Cockcroft-Gault formula when kidney function cannot be measured directly, because it is more accurate. No study has yet shown that switching changes side effects or how well treatment works.","summary":"The recommendation. ADDIKD (2025) recommends BSA-adjusted eGFR CKD-EPI as an alternative to measured GFR in the Calvert formula, on clinical consensus with a strong recommendation, and calls the switch away from creatinine clearance a significant practice change, given the long reliance on creatinine clearance calculated by the Cockcroft-Gault equation. It notes that many prescribing software packages use creatinine clearance by default.\n\nThe evidence. In 2,471 patients at Cambridge, BSA-adjusted CKD-EPI was the most accurate published estimate against measured GFR, and Cockcroft-Gault gave a dose more than 20% off in 25.5% of patients against 18.6% (Janowitz 2017, abstract). These are dose-accuracy outcomes; ADDIKD's own outstanding questions add that cystatin C-based equations may be more accurate where eGFR is unreliable.","asOf":"2026-11-11","links":[{"label":"Sandhu et al., Aligning kidney function assessment in patients with cancer to global practices in internal medicine (ADDIKD Part 1, eClinicalMedicine 2025)","url":"https://doi.org/10.1016/j.eclinm.2025.103102"},{"label":"Sandhu et al., Integrating International Consensus Guidelines for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) into everyday practice (eClinicalMedicine 2025)","url":"https://doi.org/10.1016/j.eclinm.2025.103161"},{"label":"Janowitz et al., New Model for Estimating Glomerular Filtration Rate in Patients With Cancer (J Clin Oncol 2017; abstract read)","url":"https://doi.org/10.1200/JCO.2017.72.7578"}],"tags":["protocol-upgrade","upgrade:promising","evidence:moderate"],"related":[],"cancers":[],"sections":["chemotherapy"],"technologies":["carboplatin-calvert-dosing"],"targets":[],"drugs":["carboplatin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-dose-optimisation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Carboplatin dosed with BSA-adjusted CKD-EPI eGFR produces fewer grade 3 or 4 thrombocytopenias and dose delays than dosing with Cockcroft-Gault, with no loss of response.","rationale":"A guideline-driven change to the dose of one of the most used cytotoxics should be followed by a measure of what it does to patients, not only to the arithmetic.","test":"A before-and-after or stepped-wedge study across centres adopting ADDIKD, or a randomised comparison within a trial network, recording platelet nadirs, dose delays and reductions, and response, with measured GFR in a subset to calibrate.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":3},"route":"/ideas/idea-upgrade-carboplatin-gfr-estimate-outcome-study/","neighbours":{"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"carboplatin-calvert-dosing","kind":"technology","name":"Carboplatin dosing by kidney function: the Calvert formula and how kidney function is measured","route":"/technologies/carboplatin-calvert-dosing/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"}],"bottleneck":[{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"protocol":[{"id":"carboplatin-dose-calculation","kind":"protocol","name":"Carboplatin dose calculation by the Calvert formula and kidney function","route":"/protocols/carboplatin-dose-calculation/"}]}}