Dose standardisation of anticancer drugs
Objective of the study Body size based dosing is often used for prescribing anticancer drugs. However the scientific and the clinical rationales of this historical method have recently been criticized. As a result, alternative dosing strategies have been suggested, as flat-fixed dosing regimens, but not implemented in routine practice. Dose standardisation is a first step in order to rationalise chemotherapy dose calculation. A new method, derived from dose-banding, was developed, taking into account prescription and economic criteria. Setting Feasibility and interest of this concept were studied in two French cancer centres Institut Curie and Hôpital Saint-Louis. Main outcome measures The aim of our study was to assess dose standardisation of expensive anticancer drugs in objectives of quality and economy. Method Nine candidate drugs were selected and standardized rounded doses (SRD) were proposed. To determine the specific standard doses of these two centres, two theoretical and practical methods were applied, and then, their results were compared. For each anticancer drug the objective was to fix SRD in order to cover all the doses most frequently prescribed. Results It has been possible to propose SRD for six of the nine drugs. These SRD have been implemented with the agreement of the medical staff. These doses are, whenever possible, rounded to the nearest vial size, or correspond to a combination of the different strength of the commercial drug. Conclusion Our study shows that dose standardisation is a help to optimise the productivity and improve the organisation of the preparation unit.
KeywordsAnticancer drugs Dose-banding Dose calculation Standardisation Standardized rounded doses
The authors would like to thank Dr Sandy Blondeel and Sylvie Carrie for their contribution.
Conflicts of interest
The authors declare no conflicts of interest.
- 1.DuBois D, DuBois E. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916;17:863–71.Google Scholar
- 15.Vigneron J. Stability studies of drugs used in oncology: the role of the hospital pharmacist. Eur J Hosp Pharm Pract. 2006;12:75–6.Google Scholar
- 20.Kaestner SA, Sewell GJ. Chemotherapy dosing part II: alternative approaches and future prospects. Clin Oncol (R Coll Radiol). 2007;19:99–107.Google Scholar
- 22.Leach RH, Whitmarsh S, Partridge C, Potter SR. New cytotoxics production unit at University hospital, Birmingham. Hosp Pharm. 2000;7:109–10.Google Scholar
- 23.MacLean F, MacIntyre J, McDade J, Moyes D. Dose banding of chemotherapy in the Edinburgh Cancer Centre. Pharm J. 2003;270:691–3.Google Scholar
- 24.Leth-Miller D. Dose-banding of gemcitabine. Eur J Hosp Pharm Pract. 2007;2:52.Google Scholar
- 25.Hirte HW, Kagoma S, Zhong L, et al. Dose banding of chemotherapy doses at the Juravinski Cancer Centre. J Clin Oncol. 2006;24:6099. (abstract).Google Scholar
- 27.Kaestner S, Sewell GJ. A National Survey Investigating UK Prescribers’ Opinions on Chemotherapy Dosing and ‘Dose-Banding’. Clin Oncol (R Coll Radiol). 2009;21:320–8.Google Scholar
- 31.Kaestner S, Sewell G. Pharmacoeconomic aspects of dose-banding. Hosp Pharm Eur. 2006;26:33–4.Google Scholar
- 32.Kaestner S, Walker V, Roberts S, Perren T, Sewell G. Clinical and pharmacokinetic (pk) study on “dose-banded” and individual-dose chemotherapy: An interim report. J Oncol Pharm Practice. 2004;10:100.Google Scholar
- 33.Gillian A. British Oncology Pharmacy Association: www.bopawebsite.org. Toolkit: How to implement dose banding of chemotherapy. Accessed on 08/09/2008.