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Carboplatin is a platinum-based chemotherapy drug also sold under the brand name Paraplatin®. Bristol-Myers Squibb is the original manufacturer of Paraplatin. However, there are now several companies that make the generic carboplatin. Carboplatin is used to treat a number of different cancers and is administered intravenously every one to three weeks.
Developed after cisplatin, carboplatin is an additional option for doctors. Side effects of carboplatin are typically less severe than cisplatin, although the drug still poses some risk. It can serve an important role for patients with mesothelioma and can be used in combination with several other drugs after surgical treatment or when surgery is not advised.
What is Carboplatin?
Carboplatin was developed and patented in the 1970s. However, this platinum-based chemotherapy drug was not approved by the U.S. Food and Drug Administration (FDA) until 1986, nearly a decade after the similar drug, cisplatin, had been brought to market.
Carboplatin was derived from cisplatin, its parent drug. Therefore, the two drugs have similar properties and uses. Paraplatin is made by Bristol-Myers Squibb, while generic carboplatin could be made by Hospira, Teva Pharmaceuticals, and other companies.
Like cisplatin, carboplatin works by targeting and interfering with how rapidly-growing cells divide and thrive. Unfortunately, this drug does not differentiate between cancer cells and other healthy cells that grow and divide quickly. The lack of specificity, as well as the presence of platinum, causes a number of potential side effects. Carboplatin is used for a multitude of cancer types, including ovarian, mesothelioma, and lung cancer.
Carboplatin is administered through intravenous infusion. The procedure takes about 15-60 minutes for each dose, and an infusion is administered from every one to three weeks. Carboplatin is administered by a doctor or nurse in a medical facility.
Carboplatin for Mesothelioma
Although carboplatin is not approved by the FDA for mesothelioma treatment, it is a popular choice because the National Comprehensive Cancer Network (NCCN) recommends it, especially when used in combination with other chemotherapy drugs. Patients may easily develop a resistance to carboplatin when it is used alone. Combining carboplatin with other drugs can reduce resistance, often improving the response to treatment.
A common drug combination for pleural mesothelioma is carboplatin with pemetrexed, also known as Alimta. Cisplatin has also been shown to be effective with pemetrexed. Some studies have shown that both combinations result in similar outcomes. Doctors choose the specific combinations based on how the patient tolerates each drug and any preexisting conditions such as kidney damage.
Recent trials tested carboplatin with Alimta in elderly patients with mesothelioma. The results showed that elderly patients tolerated the combination nearly as well as a younger group of participants. The older patients also had similar disease outcomes and survival times.
Additional studies tested the combination of carboplatin and pemetrexed with a third drug, bevacizumab. Bevacizumab is an anti-angiogenesis agent that works differently from chemotherapy by slowing the growth of new blood vessels to the tumor. The trial was non-randomized, and therefore had limitations. However, the strength of other trials using bevacizumab with cisplatin and pemetrexed have led the NCCN to recommend using this third agent when patients are no longer eligible for surgery.
Common Side Effects of Carboplatin
Carboplatin is often preferred over cisplatin, because it can be tolerated better by some patients. Side effects are not only uncomfortable for the patient, but may also limit medication dosage. Administering the full dose of chemotherapy is important to help treat the cancer as effectively as possible.
Carboplatin causes common side effects including nausea, diarrhea, vomiting, constipation, mouth sores, pain and tingling in hands and feet, irritation of the skin at the injection site, pain, weakness, hair loss, and change in the taste of food. Many of these are less severe and less common compared to cisplatin. An additional advantage of carboplatin over cisplatin is that it does not often cause toxicity in the kidneys, a serious potential complication of cisplatin.
Carboplatin Black Box Warnings
The FDA uses a special warning label on medications for the most severe and life-threatening side effects and complications. Carboplatin comes with a few black box warnings. Both patients and doctors should weigh the risks and consequences with the potential benefits of this drug.
One serious warning for carboplatin is that it can suppress the bone marrow. The risk of this side effect increases with dosage. The bone marrow produces new blood cells, so suppression can lead to anemia, bleeding, and infections. These side effects can be severe enough to require blood transfusions.
Another black box warning is aimed at patients with severe allergies to carboplatin injections. These severe reactions may not be discovered until after the first dose. These patients may suffer anaphylactic shock, which can be fatal without immediate treatment. Signs of a severe reaction include hives and irritation at the injection site, swelling in the face, mouth, and throat, and difficulty breathing. For this reason, carboplatin is only administered by healthcare professionals in an infusion center.
Carboplatin is a drug that was developed from cisplatin. Although these drugs are similar, there are significant differences. Some patients tolerate carboplatin better, but it still comes with serious risks. The worst risk is the drastic reduction in blood cells, resulting in anemia and a weakened immune system. Patients with mesothelioma may be given carboplatin if they cannot tolerate cisplatin. For many of these patients, it will provide good results, especially when taken in combination with other drugs.
Page Medically Reviewed and Edited by Kyle J. Becker, PharmD, MBA, BCOP
Kyle J. Becker, PharmD is certified by the Board of Pharmacy Specialties in Oncology Pharmacy. Dr. Becker earned his pharmacy degree from Shenandoah University and he currently serves as an oncology pharmacist at Parkview Cancer Institute.