Formulas calculating creatinine clearance are inadequate for determining eligibility for cisplatin-based chemotherapy in bladder cancer Journal Article


Authors: Raj, G. V.; Iasonos, A.; Herr, H.; Donat, S. M.
Article Title: Formulas calculating creatinine clearance are inadequate for determining eligibility for cisplatin-based chemotherapy in bladder cancer
Abstract: Purpose: Efficacy of formulas calculating creatinine clearance (CrCl) to determine renal function eligibility (CrCl > 60 mL/min) for cisplatin-based chemotherapy has not been examined adequately in the bladder cancer population. We hypothesize these formulas may underestimate measured CrCl, and therefore the eligibility for cisplatin-based chemotherapy. Patients and Methods: A database of 208 patients with unresectable or metastatic bladder cancer treated on protocol at Memorial Sloan-Kettering Cancer Center (New York, NY) with cisplatin-based chemotherapy between 1983 and 1994 was examined retrospectively. The association between measured and calculated CrCl and the ability to complete three cycles (minimum therapeutic) of chemotherapy was examined. Results: Baseline measured CrCl was less than 60 mL/min in 16% compared with 12% to 44% using various formulas. Concordance between calculated and measured CrCl less than 60 mL/min was poor (range of κ, 0.14 to 0.38). In patients older than age 65, 22% had a measured CrCl less than 60 mL/min, compared with 10% to 63% calculated using various formulas. Overall, 80% completed at least three cycles of cisplatin-based chemotherapy. The ability to complete at least three cycles was statistically significantly related with a measured CrCl more than 60 mL/min (P = .02), but not with calculated CrCl more than 60 mL/min. Conclusion: Current formulas estimating CrCl tend to underestimate measured CrCl, especially in those older than 65 years. Depending on the formula used, up to 44% who actually received cisplatin-based chemotherapy based on measured CrCl would be deemed ineligible at present, potentially affecting survival outcomes. Methodology for determining CrCl and/or renal eligibility for cisplatin-based chemotherapy in patients with bladder cancer should be re-examined. © 2006 by American Society of Clinical Oncology.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; cisplatin; doxorubicin; cancer combination chemotherapy; patient selection; antineoplastic agents; methotrexate; antineoplastic agent; organization and management; metabolism; multiple cycle treatment; cohort studies; antineoplastic combined chemotherapy protocols; cohort analysis; creatinine; creatinine blood level; drug effect; retrospective study; bladder cancer; bladder tumor; urinary bladder neoplasms; vinblastine; models, theoretical; cancer center; kidney; prediction and forecasting; predictive value of tests; theoretical model; creatinine clearance; eligibility determination; m vac protocol; m-vac protocol
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 19
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-07-01
Start Page: 3095
End Page: 3100
Language: English
DOI: 10.1200/jco.2005.04.3091
PUBMED: 16809735
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 22" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Ganesh Raj
    21 Raj
  2. Sherri M Donat
    148 Donat
  3. Alexia Elia Iasonos
    246 Iasonos
  4. Harry W Herr
    539 Herr