Dose banding as an alternative to body surface area-based dosing of chemotherapeutic agents

Abstract

Background:Dose banding is a recently suggested dosing method that uses predefined ranges (bands) of body surface area (BSA) to calculate each patient's dose by using a single BSA-value per band. Thus, drugs with sufficient long-term stability can be prepared in advance. The main advantages of dose banding are to reduce patient waiting time and improve pharmacy capacity planning; additional benefits include reduced medication errors, reduced drug wastage, and prospective quality control. This study compares dose banding with individual BSA dosing and fixed dose according to pharmacokinetic criteria.Methods:Three BSA bands were defined: BSA<1.7 m2, 1.7 m2⩽BSA<1.9 m2, BSA⩾1.9 m2 and each patient dose was calculated based on a unique BSA-value per band (1.55, 1.80, and 2.05 m2, respectively). By using individual clearance values of six drugs (cisplatin, docetaxel, paclitaxel, doxorubicin, irinotecan, and topotecan) from 1012 adult cancer patients in total, the AUCs corresponding to three dosing methods (BSA dosing, dose banding, and fixed dose) were compared with a target AUC for each drug.Results:For all six drugs, the per cent variation in individual dose obtained with dose banding compared with BSA dosing ranged between −14% and +22%, and distribution of AUC values was very similar with both dosing methods. In terms of reaching the target AUC, there was no significant difference in precision between dose banding and BSA dosing, except for paclitaxel (32.0% vs 30.7%, respectively; P<0.05). However, precision was significantly better for BSA dosing compared with fixed dose for four out of six drugs.Conclusion:For the studied drugs, implementation of dose banding should be considered as it entails no significant increase in interindividual plasma exposure.

The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital

“…This ascertainment could undermine the acceptance of DB built on BSA dosing. Regardless of the fact that some authors have shown no significant difference in precision (AUC versus target AUC in pharmacokinetic models) between using DB ranges and classic BSA dosing, the inaccuracy of BSA remains an important concern 15. This cannot be solved with DB.…”

Inter-patient variability in docetaxel pharmacokinetics: A review

“…This strategy was feasible, since the difference in the calculated docetaxel dosage was marginal compared to regular BSA dosing. This strategy has the potential to simplify pharmacy processes and to improve patient safety [90].…”

“…To improve the current BSA strategy, it was recently suggested that dose-banding could be an alternative [90]. A limited amount of predefined BSA ranges was used to determine an initial docetaxel dose and for adaptation of the dose in patients with extreme BSA values.…”

Contrôle analytique des préparations cytotoxiques : bilan de 7ans d’activité et perspectives

“…Une modification plus profonde des pratiques peut aussi être envisagée en abandonnant la préparation magistrale au profit d'une approche plus industrialisée (dose-banding) [24,25] où le contrôle final peut être supprimé au profit des Process Analytical Technology (PAT) [26]. Une réorganisation géogra-phique sous forme de plates-formes régionales peut aussi être une solution intéressante.…”