Carboplatin adverse effects

The major advantage of carboplatin over cisplatin is a markedly reduced risk of toxicity to the kidneys, peripheral nerves, and hearing additionally, it produces less nausea and vomiting. It is, however, more myelo-suppressive than cisplatin. Other adverse effects include anemia, abnormal liver function tests, and occasional allergic reactions. 

Like carboplatin, oxaliplatin does not usually cause nephrotoxicity. In addition, both drugs are only moderately emetogenic, in contrast to cisplatin. The most important dose-limiting adverse effect of oxaliplatin is a sensory peripheral neuropathy, which has two different forms ... 

Ocular effects, including optic neuritis, papilledema, and retrobulbar neuritis, are uncommon adverse effects of cisplatin-containing cancer chemotherapy. The risk of retinal toxicity is restricted to high-dose cisplatin therapy (for example 200 mg/m over 5 days) and can result in blurred vision and altered color perception, which can persist for several months. In contrast to cisplatin, carbo-platin is seldom involved in drug-induced visual disturbances. In two cases there was a relation between the administration of carboplatin (800-1200 mg/m ) and the occurrence of chnical cortical blindness (122). However, both patients had impaired renal function before the start of therapy with carboplatin. 

Underlying risk factors, which predispose patients to more severe forms of myelosuppression, include lower initial blood cell counts, renal impairment, poor performance status, extensive prior chemotherapy, and advanced age. There is a strong correlation between carboplatin pharmacokinetics and the severity of myelo-suppressive adverse effects an AUC-adapted dosage of carboplatin is therefore highly recommended during conventional dose chemotherapy (22,23,155). 

Nausea, vomiting, and diarrhea are common adverse effects of oxaliplatin and carboplatin, but they are generally mild to moderate, and both are less emetogenic than cisplatin. However, patients who have previously received cisplatin may be at greater risk of vomiting with carboplatin or oxaliplatin (1,8,9). 

An effective carboplatin desensitization protocol has been reported in a child with hypersensitivity, allowing additional months of carboplatin treatment (248). After premedication with diphenhydramine, ranitidine, and methylprednisolone, eight dilutions of carboplatin (0.01-50.0 mg) were given intravenously at 15-minute intervals at a rate of 1 mg/minute. Subsequently, carboplatin 600 mg was given as a continuous infusion over 3 hours without adverse effects. Whether desensitization is generally suitable for overcoming allergic adverse events should be tested prospectively (249). 

Carboplatin has a much more favorable adverse effect profile than cisplatin however, it does exhibit myelosuppression. 

The combination of radiotherapy and chemotherapy is a promising approach because of its independent cell kill effect and the property of some cytotoxic agents to enhance the effect of radiotherapy. At the end of the 1970s, platinum complexes were described as being able to act as potent radiosensitizers of hypoxic tumor cells (Dou-PLE and Richmond 1978,1979). As an obstacle in this type of chemoradiation, Koukourakis etaL (2002) have suggested that (hypoxia-induced ) overexpression of HIF-1 a in patients with head and neck cancer may be related to substantial resistance to carboplatin chemo-radiotherapy. More in-depth research is needed to accurately characterize adverse effects of hypoxia in this type of combination therapy. 

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