Many anticancer drugs are dosed according to body surface area (BSA), but they are dose adjusted according to measures of absolute kidney function (i.e.,

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Presentation transcript:

Many anticancer drugs are dosed according to body surface area (BSA), but they are dose adjusted according to measures of absolute kidney function (i.e., estimated creatinine clearance as milliliters per minute) as opposed to BSA-indexed measures of kidney ... Many anticancer drugs are dosed according to body surface area (BSA), but they are dose adjusted according to measures of absolute kidney function (i.e., estimated creatinine clearance as milliliters per minute) as opposed to BSA-indexed measures of kidney function (i.e., eGFR as milliliters per minute per 1.73 m2). (A) This practice will likely alter dose assignments of patients at the extremes of body size (patients who are obese and patients who are cachectic) compared to patients with BSA of 1.73 m2. (B) Larger patients (BSA>1.73 m2) are already receiving a larger dose of BSA-dosed drugs due to their increased BSA. Use of an absolute kidney function value may preclude necessary dose reduction, because the absolute kidney function value of patients with BSA>1.73 m2 will be greater than the BSA-indexed value and may be above a dose-adjustment breakpoint. (C) Smaller patients (BSA<1.73 m2) are already receiving a smaller dose of BSA-dosed drugs due to their decreased BSA. Use of an absolute kidney function value may lead to additional unnecessary dose reduction, because the absolute kidney function value of patients with BSA<1.73 m2 will be less than the BSA-indexed value and may be below a dose-adjustment breakpoint. Bleomycin dosing of 10 U/m2 was on the basis of manufacturer recommendations (41). Absolute eGFR values (milliliters per minute) were calculated by multiplying the BSA-indexed eGFR (milliliters per minute per 1.73 m2) by (patient’s BSA/1.73 m2). Morgan A. Casal et al. CJASN 2019;14:587-595 ©2019 by American Society of Nephrology