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Review
. 2023 May;6(5):e1811.
doi: 10.1002/cnr2.1811. Epub 2023 Mar 28.

Equivalent doses for anticancer agents used in pediatric oncology: A literature review and evaluation of a novel approach for conversion factors

Meike Ressing  1 , Cornelia Becker  1 , Christian Müller  2 , Seyed Hamidreza Mahmoudpour  1 , Gabriele Calaminus  3 , Thorsten Langer  4 , Friederike Erdmann  1 , Mathias Voigt  1 , Melanie Kaiser  1 , Peter Kaatsch  1 , Maria Blettner  5 , Claudia Spix  1
Affiliations
Review

Equivalent doses for anticancer agents used in pediatric oncology: A literature review and evaluation of a novel approach for conversion factors

Meike Ressing et al. Cancer Rep (Hoboken). 2023 May.

Abstract

Background: Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes.

Aims: The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional factors, and to compare these approaches.

Methods and results: A literature review was performed, which identified two main principles of deriving conversion factors: effect-equivalence and equimolar. Thirty-five articles presenting effect equivalence-based factors in the widest sense were found in the literature. Ten articles presented the equimolar approach which can be applied to almost all chemotherapy substances. Based on a comprehensive list of treatment protocols used in German pediatric oncology, we derived alternative conversion factors from typical doses. We compared the conversion factors using Pearson correlation coefficients and linear regression. At least two types of conversion factor were available for each of the 49 substances included. The equivalent effect-based and the typical dose-based factors were highly correlated with a regression coefficient close to 1. The equimolar factors are independent.

Conclusions: For substances for which no conversion factor based on some type of effect equivalence has been published so far, a factor based on a typical doses-approach may be used in epidemiological late effects research. Doses aggregated based on the equimolar approach may not be compatible with doses aggregated based on equivalent effects.

Keywords: chemotherapeutics; childhood cancer; conversion factors; doses; second tumor.

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Conflict of interest statement

Seyed Hamidreza Mahmoudpour is currently an employee of Merck KGaA, Darmstadt, Germany. All other authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of inclusion and exclusion of identified articles. *One study is mentioned twice because it referred to molecular weights and in a second analysis assumed equality between substances
FIGURE 2
FIGURE 2
Scatter plot and regression line of the factors based on effect equivalence from literature review and the factors based on typical dose (derived from treatment protocols in pediatric oncology in Germany). CLI, confidence limits for the individual predicted values; CLM, confidence limits for the mean predicted values
See this image and copyright information in PMC

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