Carboplatin (Paraplatin)
Platinum-Based Alkylating Agent
Generic Name
Carboplatin
Brand Name
Paraplatin
Drug Class
Alkylating Agent
Administration
IV Infusion
⚠️ BLACK BOX WARNING
- Carboplatin should be administered under supervision of qualified physicians experienced in cancer chemotherapy
- Severe bone marrow suppression with resulting infection or bleeding may occur
- Anaphylactic-like reactions may occur within minutes of administration
- Vomiting is a frequent side effect - antiemetic medication recommended
Overview
Carboplatin is a second-generation platinum-based chemotherapy drug that is less nephrotoxic and neurotoxic than cisplatin. It forms DNA cross-links that inhibit DNA synthesis and trigger apoptosis. Carboplatin is commonly used in combination regimens for various solid tumors.
Key Features
- Better tolerated than cisplatin with less nausea, nephrotoxicity, and neurotoxicity
- Dosed based on AUC (area under the curve) using Calvert formula
- Primary toxicity is myelosuppression, particularly thrombocytopenia
- Can be given in outpatient setting
- No prehydration required unlike cisplatin
FDA-Approved Indications
Primary Indications
- Ovarian Cancer:
- First-line in combination with paclitaxel
- Recurrent disease after prior chemotherapy
- Lung Cancer:
- Non-small cell lung cancer (with paclitaxel or pemetrexed)
- Small cell lung cancer (with etoposide)
Common Off-Label Uses
- Breast cancer (triple-negative)
- Head and neck cancers
- Bladder cancer
- Testicular cancer
- Endometrial cancer
- Cervical cancer
- Malignant gliomas
- Retinoblastoma
- Neuroblastoma
Mechanism of Action
Carboplatin is a platinum coordination compound that acts as an alkylating agent:
- Activation: Undergoes hydrolysis to form active platinum complexes
- DNA Binding: Forms covalent bonds with nucleophilic sites on DNA bases (primarily guanine N7)
- Cross-link Formation: Creates intrastrand and interstrand DNA cross-links
- Cell Cycle Arrest: Prevents DNA replication and transcription
- Apoptosis: Triggers programmed cell death pathways
Resistance Mechanisms
- Decreased drug accumulation (reduced uptake/increased efflux)
- Increased DNA repair (nucleotide excision repair)
- Increased glutathione and metallothionein levels
- Defects in apoptotic pathways
Pharmacology
Pharmacokinetics
- Distribution: Vd = 16 L; minimal protein binding (0-24%)
- Metabolism: Minimal hepatic metabolism; undergoes hydrolysis
- Elimination: Primarily renal (70% in 24 hours)
- Half-life: Terminal t½ = 3-6 hours (longer with renal impairment)
- Clearance: Correlates with GFR
Special Populations
- Renal Impairment: Dose adjustment required (use Calvert formula)
- Hepatic Impairment: No specific adjustment needed
- Elderly: May require dose reduction due to decreased renal function
- Pregnancy: Category D - can cause fetal harm
Dosing and Administration
Calvert Formula for AUC-Based Dosing
Total Dose (mg) = Target AUC × (GFR + 25)
Where GFR is glomerular filtration rate in mL/min
Note: Maximum GFR used should be 125 mL/min to avoid overdosing
Common Dosing Regimens
| Indication | Dose/AUC | Schedule | Combination |
|---|---|---|---|
| Ovarian Cancer | AUC 5-6 | Every 3 weeks | With paclitaxel |
| NSCLC | AUC 6 | Every 3 weeks | With paclitaxel |
| SCLC | AUC 5-6 | Every 3 weeks | With etoposide |
| Head & Neck | AUC 5 | Every 3 weeks | With 5-FU or paclitaxel |
| Single Agent | 360 mg/m² | Every 4 weeks | Monotherapy |
Dose Modifications
- Platelets <50,000/mm³: Hold until recovery
- ANC <1,000/mm³: Hold until recovery
- Grade 3-4 non-hematologic toxicity: Reduce dose by 25%
- CrCl <60 mL/min: Use Calvert formula with actual GFR
Side Effects
Common (>30%)
- Myelosuppression
- Thrombocytopenia (nadir day 21)
- Neutropenia
- Anemia
- Nausea and vomiting
- Fatigue
- Hair loss (mild)
Frequent (10-30%)
- Peripheral neuropathy (less than cisplatin)
- Elevated liver enzymes
- Elevated creatinine
- Electrolyte abnormalities
- Hypomagnesemia
- Hypocalcemia
- Hyponatremia
- Hypokalemia
- Abdominal pain
- Diarrhea or constipation
Occasional (<10%)
- Hypersensitivity reactions
- Ototoxicity (rare vs cisplatin)
- Visual disturbances
- Taste changes
- Hemolytic uremic syndrome (rare)
- Secondary malignancies
Serious Adverse Events
- Severe myelosuppression: Can be life-threatening
- Hypersensitivity reactions: Risk increases with multiple cycles
- Tumor lysis syndrome: In sensitive tumors
- Posterior reversible encephalopathy syndrome: Rare
Contraindications & Warnings
Absolute Contraindications
- Severe hypersensitivity to carboplatin or platinum compounds
- Severe bone marrow suppression
- Significant bleeding
Warnings and Precautions
- Bone Marrow Suppression: Monitor blood counts closely
- Hypersensitivity: Risk increases after 6+ cycles
- Renal Toxicity: Less than cisplatin but still monitor
- Hepatotoxicity: Monitor liver function
- Pregnancy: Effective contraception required
- Fertility: May cause infertility in both sexes
Use with Caution
- Renal impairment (adjust dose)
- Hearing impairment
- Prior radiation therapy
- Elderly patients
- Prior platinum therapy
Drug Interactions
| Drug/Class | Interaction | Management |
|---|---|---|
| Nephrotoxic drugs | Increased kidney damage risk | Monitor renal function closely |
| Aminoglycosides | Enhanced nephrotoxicity and ototoxicity | Avoid if possible |
| Loop diuretics | Increased ototoxicity risk | Monitor hearing |
| Phenytoin | Reduced phenytoin levels | Monitor levels, adjust dose |
| Live vaccines | Risk of infection | Avoid during treatment |
| Warfarin | Altered INR | Monitor INR frequently |
| Taxanes | Sequence-dependent interaction | Give taxane before carboplatin |
Monitoring Parameters
Before Each Cycle
- CBC with differential and platelets
- Comprehensive metabolic panel (renal function, electrolytes)
- Liver function tests
- Magnesium, phosphate
- Assessment of neuropathy symptoms
Periodic Monitoring
- Weekly during nadir: CBC if severe myelosuppression
- As indicated: Audiometry if ototoxicity suspected
- Long-term: Monitor for secondary malignancies
Hypersensitivity Monitoring
- Observe closely during infusion, especially after cycle 6
- Have emergency medications readily available
- Consider skin testing if prior reaction
Administration Guide
Preparation
- Available as 50mg, 150mg, 450mg, 600mg vials
- Dilute in D5W or NS to concentration 0.5-2 mg/mL
- Stable for 8 hours at room temperature after dilution
- Do not use aluminum-containing equipment
- Use within 8 hours of preparation
Administration
- Route: IV infusion only
- Duration: Typically 15-60 minutes
- Premedications:
- Antiemetics (5-HT3 antagonist + dexamethasone)
- Consider H1/H2 blockers after multiple cycles
- Hydration: Not required (unlike cisplatin)
Extravasation Management
- Carboplatin is an irritant, not a vesicant
- Stop infusion immediately
- Aspirate residual drug
- Apply ice for 15-20 minutes QID × 24 hours
- Elevate extremity
Patient Counseling Points
Key Information for Patients
- Blood counts: Will be monitored regularly; report fever, unusual bleeding/bruising
- Infection risk: Avoid sick contacts, practice good hygiene
- Nausea: Take anti-nausea medications as prescribed
- Contraception: Use effective birth control during and 6 months after treatment
- Fertility: May affect ability to have children
When to Contact Healthcare Provider
- Fever ≥100.4°F (38°C)
- Signs of infection
- Unusual bleeding or bruising
- Severe nausea/vomiting not controlled by medication
- Numbness/tingling in hands or feet
- Hearing changes or ringing in ears
- Allergic reaction symptoms
- Severe fatigue or weakness
Lifestyle Modifications
- Stay hydrated (unless fluid restricted)
- Eat small, frequent meals
- Avoid raw foods during neutropenia
- Use soft toothbrush
- Avoid NSAIDs without approval
Cost & Financial Assistance
Cost Information
- Generic available: Yes - significantly reduces cost
- Average wholesale price: $50-200 per cycle (generic)
- Insurance coverage: Generally covered by Medicare Part B and commercial insurance
Financial Assistance Programs
- Patient assistance programs through manufacturers
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation
- Good Days (formerly CDF)
- Hospital financial assistance programs
Cost-Saving Tips
- Use generic version when available
- Check if eligible for 340B pricing
- Compare prices between treatment facilities
- Ask about financial counseling services
Related Information
Medical Disclaimer
This drug information is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult with qualified healthcare providers regarding medications and treatment decisions. Dosing and recommendations may vary based on individual patient factors and institutional protocols.
References
- Carboplatin [package insert]. Various manufacturers. Revised 2025.
- National Comprehensive Cancer Network. NCCN Drugs & Biologics Compendium. 2026.
- Calvert AH, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol. 1989;7(11):1748-56.
- Micromedex Solutions. Carboplatin monograph. Truven Health Analytics. 2026.
- Clinical Pharmacology. Carboplatin drug monograph. Elsevier. 2026.
- Lexicomp Online. Carboplatin. Hudson, OH: Wolters Kluwer. 2026.