Paraplatin (Carboplatin)

Carboplatin is a chemotherapy drug that is platinum-based and that is also sold under the brand name Paraplatin. The maker of Paraplatin is Bristol-Myers Squibb, but there are now several companies that make the generic carboplatin. It is used to treat a number of different cancers, including mesothelioma, and is administered like other chemotherapy drugs, intravenously every few weeks.

Developed after cisplatin, carboplatin is an addition to the options doctors have for prescribing patients with chemotherapy drugs. It causes fewer and less severe side effects in many patients but still comes with some risks. Carboplatin is an important chemotherapy drug for patients with mesothelioma, and it can be used in combination with several other drugs after surgical treatment or when surgery is not advised.

What is Carboplatin?

Carboplatin, or Paraplatin, is a platinum-based chemotherapy drug. It was developed and patented in the 1970s but was not approved by the U.S. Food and Drug Administration (FDA) until 1986, nearly a decade after the similar cisplatin had been on the market. Carboplatin was derived from cisplatin, its parent drug, so the two have a lot of the same properties and uses. Paraplatin is made by Bristol-Myers Squibb and generic carboplatin is made by Hospira, Teva Pharmaceuticals, and other companies.

Like cisplatin, carboplatin works by seeking out and interfering with how rapidly-growing cells grow and divide. This means it targets both cancer cells and healthy cells that grow and divide quickly. The lack of specificity, as well as the presence of platinum, a heavy metal, causes a number of potential side effects. A main use for carboplatin in combination with other drugs is to treat ovarian cancer, but it has been tested and used for a number of other cancer types, including mesothelioma and lung cancer.

Patients undergoing therapy with carboplatin can expect to receive an intravenous injection that takes about 15 minutes. It is circulated throughout the body through the bloodstream and is given approximately every four weeks. Carboplatin is administered by a doctor or nurse in a medical facility setting.

Carboplatin for Mesothelioma

Although carboplatin is not officially approved for treating mesothelioma, it is a popular choice, especially in combination with other chemotherapy drugs. Patients may develop a resistance to carboplatin when it is used alone. The cancer cells develop immunity to it and this often leads to a relapse. Combining carboplatin with other drugs can reduce the effect of resistance.

A common combination currently used for pleural mesothelioma is carboplatin with pemetrexed, also known as Alimta. This is also a common combination with cisplatin. Some studies have shown that both combinations, using Alimta with either cisplatin or carboplatin, result in similar outcomes. The one that a doctor may choose to use depends on how the patient tolerates each drug.

Other trials using carboplatin recently have included its use 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 and had similar disease outcomes and survival times. Another group of trials has not yet come up with significant results, but are trying to combine carboplatin and Alimta with a third drug, bevacizumab, a chemotherapy drug that works in a different way. The trial was non-randomized, and therefore limited, so the researchers hope to be able to test the combination again and more effectively.

Common Side Effects of Carboplatin

Carboplatin is often preferred over cisplatin because it causes fewer of the common side effects that patients experience with the latter. Side effects are not only uncomfortable for the patient, but they may also limit how much of the medicine can be administered. The fewer side effects, the more the patient can tolerate.

Common side effects caused by carboplatin therapy include nausea, diarrhea, vomiting, constipation, mouth sores, pain and tingling in hands and feet, irritation in the skin at the injection site, pain, weakness, hair loss, and loss of taste for food. Most of these are less severe or less often seen in patients as compared to cisplatin. Another big advantage of carboplatin over cisplatin is that it does not 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 and both patients and doctors need to weigh the risks and consequences of these side effects with the potential benefits of using the drug.

One warning is that carboplatin may suppress bone marrow. This side effect is dependent on the dose, with the risk increasing with dosage. Bone marrow suppression can be severe in people on carboplatin and can result in anemia, bleeding, and infections. The issue can be severe enough to require that a person get blood transfusions to treat it. Bone marrow is what produces new blood cells in the body, so suppression leads to anemia, with inadequate red blood cells. It can also lead to infections because the blood has inadequate white blood cells, the cells of the immune system that fight infections.

Another important black box warning is that some people have severe allergies to carboplatin injections that may not be discovered until the first dose is given. These patients may suffer anaphylactic shock, which can be fatal if not treated immediately. Signs of a severe reaction include hives and irritation at the injection site, swelling in the face, mouth, and throat, and difficulty breathing.

Carboplatin is a drug that was developed from cisplatin, and while both are similar to each other, there are significant differences. Some patients tolerate carboplatin better, but it comes with serious risks. The worst of these is the drastic reduction in blood cells, especially white blood cells, resulting in anemia and the potential for serious infections. Patients with mesothelioma may be given carboplatin if they cannot tolerate cisplatin, and for many of these it will provide good results, especially when taken in combination with other drugs. Further studies of how carboplatin can be used may help even more patients.