CARBOPLATIN

Indications

• Ovarian cancer
• Testicular cancer
• Small cell lung cancer
• Non-small cell lung cancer
• Head and neck cancers
• Bladder cancer

Dosage

Children: Refer to the BNF for Children for appropriate dosing recommendations based on the child's weight, age, and specific condition.

Adults: Refer to the BNF for specific dosing guidelines based on the type of cancer being treated, patient weight, and renal function.

Mechanism of action

Carboplatin exerts its cytotoxic effects by forming DNA cross-links. The drug binds to DNA, leading to the formation of intrastrand cross-links that inhibit DNA replication and transcription. This ultimately triggers cellular apoptosis (programmed cell death) in rapidly dividing cancer cells. The action of carboplatin is somewhat similar to that of cisplatin but with a different toxicity profile.

Pharmacodynamics

Carboplatin has dose-dependent antitumor activity. Its effectiveness is influenced by factors such as the tumor type, the presence of specific biomarkers, and the patient's overall health. The drug's pharmacodynamic profile is characterized by its ability to induce apoptosis in cancer cells through DNA damage, with effects observed in both dividing and non-dividing cells. The therapeutic window is narrow, and careful monitoring is required to minimize adverse effects.

Pharmacokinetics

After intravenous administration, carboplatin is distributed widely throughout the body. It has a volume of distribution of approximately 4 to 8 L/m². The drug is primarily eliminated through renal excretion, with a half-life ranging from 1 to 3 hours. Its clearance is significantly affected by renal function; hence dose adjustments may be necessary in patients with impaired renal function. Carboplatin is less nephrotoxic compared to cisplatin, but it can still cause renal impairment.

Contra-indications

• Hypersensitivity to carboplatin or any of its components
• Severe myelosuppression
• Renal impairment

Adverse effects

• Nausea
• Vomiting
• Myelosuppression
• Thrombocytopenia
• Neutropenia
• Anemia
• Ototoxicity
• Peripheral neuropathy
• Hypersensitivity reactions

Interactions

• Other myelosuppressive agents
• Live vaccines
• Aminoglycosides (increased risk of ototoxicity)
• Anticonvulsants (may affect the metabolism of carboplatin)

Precautions

• Monitor renal function prior to and during treatment
• Use caution in patients with pre-existing hearing impairment
• Monitor for signs of infection due to myelosuppression
• Hydration is recommended to reduce nephrotoxicity

Pregnancy

Carboplatin is classified as category D. It may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to use effective contraception during treatment.

Breast-feeding

It is not known whether carboplatin is excreted in human milk. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from light and moisture. Reconstituted solutions should be used immediately or stored refrigerated and used within 24 hours.

Formulations

• Injection: 10 mg/mL in 50 mL vials
• Injection: 50 mg/mL in 50 mL vials