HONOURABLE MENTION PROJECT WINNER: INTERPROFESSIONAL PROGRAMS

Dominic Duquette
CHU de Québec

Interprofessional Optimization of Carboplatin Dosing in Oncology: Implementation of a Practice Based on CamGFR and Clinical Evidence

Rethinking Carboplatin Dosing: Implementing CamGFR to Improve Precision and Patient Safety in Oncology

Accurate estimation of renal function is a critical step in carboplatin dosing, as dosing is determined directly through the Calvert formula. Even modest inaccuracies in glomerular filtration rate (GFR) estimation can result in clinically meaningful overdosing, increased toxicity, and treatment interruptions that may compromise treatment outcomes.

This project emerged following the merger of two major oncology centers in Quebec City. At the time, each institution used a different equation to estimate renal function: one relied on the Cockcroft–Gault formula, while the other used CKD-EPI. Harmonizing clinical practices between the two centers provided an opportunity to reassess the scientific evidence and identify the most appropriate approach for oncology patients.

A comprehensive literature review led to the identification of CamGFR, a formula developed and validated specifically in cancer patients. Compared with traditional equations derived from chronic kidney disease populations, CamGFR has demonstrated superior accuracy in estimating renal function in oncology settings, making it particularly relevant for chemotherapy dosing.

However, the complexity of the CamGFRv2 formula represented a barrier to routine clinical use. To facilitate implementation, an automated Excel-based calculator was developed and integrated into the clinical workflow. The tool incorporates macros and a barcode system that allows the calculated result to be transferred directly into the patient’s electronic medical record, eliminating manual transcription and enabling efficient use in daily practice.

To evaluate the clinical implications of using CKD-EPI instead of CamGFR, a retrospective review of 100 patients treated with carboplatin across the two centers was conducted. Results showed that 26% of patients received a carboplatin dose at least 15% higher than if CamGFR was used. This discrepancy was associated with frequent hematologic toxicities, treatment delays, and dose reductions, resulting in an overall dose intensity of only 75%, with more than one third of patients unable to complete their planned treatment.

Following this work, CamGFR has been adopted as the institutional standard for estimating renal function and guiding carboplatin dosing. This initiative demonstrates how optimizing a fundamental step in chemotherapy dosing can significantly improve treatment precision, patient safety, and the quality of oncology care.