BASIC CALCULATION IN

CHEMOTHERAPY PRESCRIPTIONS
 Chemotherapy dose

• Optimal chemoterapy dose based on

clinical trial data
• Doses are individualized
• Measured weights should be obtained at
the time the chemotherapy is
prescribed to help ensured accurate
dosing , each chemotherapy treatmen
cycle, doses adjusted for weight gain or
loss
 Determine chemotherapy doses
Body weight BSA AUC GFR

• Estimating
• ……mg/kgBB • ……mg/m2 • Target AUC renal function
• Young • Carboplatin • Carboplatin
• adults dosing
children & dosing in
infant Adult • dosing
Adjustment
 Body Surface Area
Formulae (m2)
• DuBois & DuBois 1916
BSA = 0.20247 x Ht (m) 0.725 x Wt (kg) 0.425
• Boyd 1935
BSA = 0.0003207 x Ht (cm) 0.3 x Wt (g) 0.7285-(0.0188 x log(g)
• Gehan & George 1970
BSA = 0.0235 x Ht (cm) 0.42246 x Wt (kg) 0.51456
• Haycock et al. 1978
BSA = 0.024265 x Ht (cm) 0.3964 x Wt (kg) 0.5378
• Mosteller 1987
BSA =
Ht (cm) x Wt (kg) 3600
COMPARISON OF BSA FORMULAE RESULTS
 BSA, which formula should we use?

ASCO No evidence Mosteller

recommends supporting one formula is most
any of the formula over commonly
formula another used
 Become standard for determining BSA
Why Mosteller
?
• It has been validated against other BSA
formulas.
• It removes the chance of mathematical error if
the patient’s height and weight are inadvertently
switched in the calculation.
• It is much easier to remember and therefore will
find more widespread use in clinical practice.
• It is applicable to children.
 How to calculate chemotherapy dose?
Mr Z, colorectal carcinoma , chemotherapy protocol
XELOX. height= 168 cm; weight 57 kg.
XELOX
Oxaliplatin 130 mg/m2 D1
Capecitabine 1000 mg/m2 bid po D1-14

Calculation :

XELOX
Oxaliplatin 130 mg/m2 130 X 1.63 = 211.9 mg
Capecitabine 1000 mg/m2 bid po 1000 X1.63 = 1630 mg
Calculation of Safe Dosage by BSA
• Pasien nama Davi, 7 tahun TB:126 cm
BB: 23 kg.
• Mendapatkan R/: Oncovin 1.8 mg IV
(jam 10 pagi)
• Apakah dosis tepat?
• Dosis yang direkomendasikan 2 mg per
m2 .

9
Calculation of Safe Dosage by BSA

10
Calculation of Safe Dosage by BSA
• Determine BSA
126  23 2,898
BSA (m ) =
2 = = 0.805 = 0.897 m2 = 0.9 m2
3,600 3,600
• Calculate recommended dosage
Mg per m2 × m2 = 2 mg per m2 × 0.9 m2 = 1.8 mg
pertanyaannya.,
• Apakah dosis tepat/tidak tepat
• Berapa ml oncovin yang harus diambil
11
untuk dosis tersebut?
Calculation of Safe Dosage by BSA
• Berapa ml oncovin?
– Use ratio-proportion:

1 mg 1.8 mg
= X = 1.8 mL
1 mL X mL

– Oncovin 1.8 mL

12
 AUC, CARBOPLATIN
• Myelotoxicity and clinical efficacy of carboplatin
correlate with the clearence of the drug , which is
correlated to the glomerular filtration rate (GFR),
renal function

• AUC is used to determine carboplatin doses

• AUC is the area under curve when the

concentration of a drug in plasma is plotted
against time.

• Target AUC → 4 to 7 mg/ml/minute

 CARBOPLATIN DOSE CALCULATION

• Ny AD 53 tahun, Ca. Ovarium, mendapatkan

kemoterapi carboplatin, BB = 50 Kg, TB = 160
cm, GFR = 70 ml/min, target AUC 5. hitung dosis
carboplatin !

PERHITUNGAN:
• Dosis carboplatin = 5 x (70+25) = 475 mg
→ Berapa ml carboplatin yang harus diambil untuk dosis
tersebut?
 CARBOPLATIN DOSE CALCULATION

Ny AD 53 tahun, Ca.
Ovarium, BB = 50 Kg,
TB = 160 cm,
GFR = 70 ml/min,
target AUC 5. hitung dosis
carboplatin !

PERHITUNGAN:

• Dosis carboplatin = 5 x (70+25) =

475 mg
 mL carboplatin

10 mg 475 mg
• x
mL Z

• 10 Z mg = 475 mg mL
• Z = 47.5 mL
 Drug
Obese
interaction

Poor
Low blood
nutritional
cell counts
status

Dosing Liver or
elderly kidney
adjustment disease
 Other Calculation

Cumulative Corticosteroid
GFR dose conversion ANC
anthracyclin dose
GFR, ESTIMATION OF RENAL FUNCTION

Important information prior to

starting chemotherapy

Glomerular filtration rate

(GFR→ renal function

Creatinin Clearance, Serum

Creatinin
 FORMULA TO CALCULATE ESTIMATED GFR

METHOD FORMULA
Cockroft and Female =
Gault malex0.85
(ml/min)

MDRD Male =0
Female =1
Comparing Different GFR Formula
 Menghitung GFR
• Ny. Wati 37 tahun
• BB = 65 kg, TB = 170 cm
• Hasil pemeriksaan Lab

• Estimated GFR!
• GFR = X 0.85

= (140 – 37) x 65 X 0.85

72 x 1.27
= 62.23 ml/menit/1.73 m2
Anthracycline Cumulative Dose
Recommended cumulative maximum anthracycline doses
 Contoh Perhitungan
Pasien Tn. RM dengan Non-Hodgkin’s Lymphoma telah
menjalani 6 x kemo R-CHOP dan 2x IVE, berapa banyak
antrasiklin yang telah digunakan oleh pasien?

R-CHOP, to be repeated every 3 weeks (6 course)

Cyclophosphamide 750mg/m2 i.v d1

Doxorubicin 50 mg/m2 i.v d1

Vincristine 1.4 mg/m2 (max 2 mg) i.v d1

Prednisone 100 mg/m2 p.o d1-5

Rituximab 375 mg/m2 i.v d0

IVE

Ifosfamide 2500 mg/m2 i.v d1-3

Etoposide 150 mg/m2 i.v d1-3

Epirubicin 50 mg/m2 i.v d1

Anthracycline Cumulative Dose
PROTOKOL PERHITUNGAN
6xR-CHOP 6x50 mg/m2 = 300 mg/m2 doxorubicin
˷ 2/3 cumulative anthracycline

2xIVE 2x50 mg/m2 = 100 mg/m2 epirubicin

˷ 1/9 cumulative anthracycline

total 2/3 + 1/9 = 7/9 cumulative anthracyclin

dose

Kesimpulan:……..?
Corticosteroid conversion dose
Comparison Chart
 Contoh Perhitungan Kortikosteroid

PasienanakJN,akanmendapatkaninjeksihidrokortison12mg.Hidrokortison
injeksitidaktersediadisatelitfarmasi,makadokterberencanamengganti
dengandeksametasoninjeksi.Doktermemintafarmasimenghitungdosis
deksametasoninjeksi…!
 Dosis dexamethason

Kortikosteroid Equivalentdose Dosispasien(mg)

(mg)
Hidrokortison 20 12
deksametason 0.75 ??

dexamethason (0.75x12):20 0.45

 Absolute Neutrophil Count (ANC)
Calculation
guidelines
Chemotherapy
intensity • Mild Neutropenia =
ANC 1000/µL - 1500/µL
(minimal risk of infection)
Prolonged
hospitalization neutropenia • Moderate Neutropenia =
ANC 500/µL - 1000 /µL
(moderate risk of infection)
• Severe Neutropenia =
ANC < 500/µL
sepsis
Febrile (severe risk of infection)
neutropenia

Chemotherapy is usually not given to a patient

with an ANC < 1000 (but other circumstances
may change this parameter)
 Absolute Neutrophil Count (ANC)
Calculation

• Contoh perhitungan:
Leukosit = 1600 /µL Leukosit = 5200 /µL
Segmen = 48 % Segmen = 4 %
Batang = 5 % Batang = 8 %

ANC = (48+5) X 1600 ANC = (4+8) X 5200

100 100
ANC = 848 /µL ANC = 624 /µL
 SOAL

Ny MN, 65 tahun dengan kanker endometrium, saat ini

rencana kemoterapi protokol Paclitaxel + Carboplatin
siklus pertama, TB = 165 cm, BB= 62 kg

Instruksi dokter:
• Paclitaxel 294 mg + NS 250 ml, selama 3 jam
• Carboplatin 589 mg + D5 250 ml, selama 60 menit,(target
AUC =6)

Lakukan identifikasi, verifikasi protokol dan perhitungan

dasar sebelum merekonstitusi!
 Yang dibutuhkan…
• Identifikasi pasien
• Nama, No. MR dan Tanggal Lahir
• Hasil pemeriksaan penunjang
• Hasil Lab PA/PK, dst
• Verifikasi protokol
• Guideline & Fornas
• Informasi sediaan
• ….mg/…ml, amp/vial, data stabilitas
Hasil Pemeriksaan Lab
Guideline vs fornas
 Informasi yang dibutuhkan

Paclitaxel Carboplatin

• Sediaan 30 mg/5 ml • Sediaan 450 mg/45 ml

• Sediaan 100 mg/16.7 ml • Sediaan 150 mg/15 ml
 PENYELESAIAN

STEP 1 IDENTIFIKASI PASIEN

STEP 2 VERIFIKASI PROTOKOL

STEP 3 PERHITUNGAN DOSIS

STEP 4 REKONSTITUSI

STEP 5 ETIKET
 PENYELESAIAN
STEP 1 IDENTIFIKASI PASIEN

Nama : Ny. MN
No. MR :
Tanggal lahir :
STEP 2 VERIFIKASI PROTOKOL

Kesesuaian indikasi klinis

Guideline Fornas
Sesuai/tidak sesuai Sesuai/tidak sesuai
STEP 3 PERHITUNGAN DOSIS

Paclitaxel Carboplatin

GFR= X0.85

BSA = √ (165x62) : 3600 GFR= (140-65)x 62 x 0.85

BSA = 1,68 m2 72x 0.75
GFR= 73.2 ml/menit
Dosis Dosis
Paclitaxel 175 mg/m2 Carboplatin, AUC 6
= 175 X 1. 68 = AUC (GFR+25)
= 294 mg = 6 x (73.2 + 25)
= 589 mg

Kesimpulan dosis : Kesimpulan dosis :

Tepat / tidak tepat Tepat / tidak tepat
STEP 4 REKONSTITUSI
Keterangan Paclitaxel Carboplatin
30 mg/5 ml & 450 mg/45 ml &
100 mg/16.7 ml 150 mg/15 ml

Dosis 294 mg 589 mg

Cara pemberian Drip Drip

Nama & volume infus Nacl 0,9% 250 ml Dextrose 5% 250 ml

Jumlah ampul/vial 100 mg/16,7 ml = 3 vial 450 mg/45ml = 1 vial

150 mg/15ml= 1 vial

Volume obat yg (294mg:100mg)x16,7 ml (589mg:10mg)x1 ml

diambil = 49.1 ml = 58,9 ml

Volume syringe spuit 50 ml spuit 50 ml

Volumen akhir 250 ml + 49.1 ml = 299.1 250 ml + 58,9 ml =

campuran ml 308,9 ml
STEP 6 ETIKET

Nama : Ny.MN
MR : 12-34-56
Tgl Lahir : 20 Januari 1950

Obat : Carboplatin 589 mg dalam

Dextrose 5% 250 ml
Rute pemberian : Drip
Tanggal dan Waktu penyiapan : 26 Nop 15, jam 10.00 WIB
Tanggal dan Waktu Kadaluarsa : 26 Nop 15, jam 18.00 WIB
TERIMA KASIH