Carboplatin is a chemotherapy agent used for treatment of many types of cancer. Currently, it is approved by the Food & Drug Administration (FDA) for treating patients with ovarian and non-small cell lung cancer. However, some oncologists use carboplatin “off-label” for other cancers. Commonly, these “off-label” uses include testicular, stomach, and bladder cancers as well as other carcinomas.
Some doctors are examining the efficacy of carboplatin as a second line chemotherapy agent (after the failure of taxotere) as well as along with taxotere therapy for men with advanced prostate cancer. Some web sites about the use of carboplatin with and after taxotere are:
There is an on-going clinical trial (NCT00514540) at MD Anderson (not recruiting) evaluating carboplatin with taxotere
There is also a report from ASCO about a small study of carboplatin as a second line chemotherapy which did show some limited benefits, but no life extension for some men.
Carboplatin works by binding to DNA causing it to be damaged. The resulting DNA damage caused by the carboplatin results in cell death or apoptosis. In the United States it is marketed under the brand name Paraplatin; it may also be referred to as CBDCA, JM-8, or carboplatinum.
When using carboplatin blood counts must be monitored regularly. After receiving carboplatin there is an increased risk of getting infections so caution should be taken to avoid unnecessary exposure to infectious agents. It is also important that you check with your doctors before receiving live virus vaccines while on any chemotherapy drug, including carboplatin.
The most common side effects from receiving carboplatin are nausea and vomiting. These effects can begin up to six hours after treatment and can last as long as 24 hours. It is possible to take antiemetics before receiving carboplatin to help prevent or decrease this side effect. Diarrhea, loss of appetite, constipation, pain, and weakness have also been reported to occur.
Myelosuppression, or a suppression of bone marrow activity resulting in a low blood cell count, is also expected following carboplatin administration. When this happens the white blood cell count drops below normal (leukopenia) and there is an increased risk of developing a fever and infections. Neupogen, a drug used to increase the white blood cell count, may be administered to counter this problem.
A decrease in platelet count is most notable following carboplatin administration. Platelets are blood cells that aid for the formation of clots. When the platelet count becomes abnormally low, patients are at an increased risk for bruising and bleeding. If the platelet count remains too low a platelet blood transfusion is an option. Low red blood cell counts (anemia) may also occur following many cycles of carboplatin administration; during the first cycles this is usually not a common problem. Low red blood cell counts may result in dizziness and fatigue and can be treated with the drug erythropoietin.
A less common side effect of carboplatin is damage to nerves and nervous system tissues. Patients may feel tingling and numbness of the fingers and toes. Other less common side effects include rash, itching, hair loss (alopecia), mouth sores, hearing problems, kidney problems, liver problems, vision problems, swelling, redness and pain at the site of injection, allergic reactions, heart problems, and breathing problems.
It is also possible to develop hypersensitivity or allergic reactions to carboplatin that may include difficulty breathing, rash, itching, redness in the face, dizziness, an increased heart rate, and a drop in blood pressure. The risk of such reactions is increased in patients who have had more than six cycles of treatment with the drug. The good news is that a group of researchers in Ohio has developed a skin test to evaluate patients for possible hypersensitivity reactions to carboplatin, and a second team is working on a desensitization regimen that will allow patients who have become hypersensitive to the drug to continue to benefit from treatment with it.
Since cabazitaxel has been approved post taxotere therapy and it does show life extension one needs to question the rational for this research as cab is a better alternative. Perhaps it now needs to be evaluated as an agent post cabazitaxel.
Joel T. Nowak, M.A., M.S.W.
If you remember I am a practicing community urologist. I received both taxatere and carboplatin up front for my metastatic to bone Gleason 9 prostate cancer. I received 4 cycles of each at 3 week intervals 3 months after starting ADT.
These treatments were the initial treatments as I presented with the bone mets after a sudden jump of my PSA from 1.8 to 5.6. The tumor has some signet cell elements. I had no major difficulties with the chemotherapy, perhaps as I did it upfront while I was relatively healthy. I had mild nausea without vomiting controlled with Zofran. I took Neulasta to raise my WBC count. That gave me flu like symptoms.
I am 20 months out from the start of the ADT. I get imaged every 6 months and Zometa every 3 months. I continue on Lupron and recently had to stop the Casodex as I developed some pulmonary fibrosis which appears to be a class effect not discussed often with Casodex. This is controlled with inhalers. My PSA is 0.01 however my fear is that I will have progression not reflected in my PSA levels. I have seen this as a urologist and it is rather scary for all involved.
I was fortunate enough to get Provenge which I completed on Valentines Day this year. My main problem with that was difficulty with the internal jugular line which never worked properly. The Provenge was covered by my insurance. Dana Farber charged $51,000 for each treatment(medication only) and received $31,000. I am told Mass general Hospital charges $120,000 for each of the 3 treatments.
My main problem is fatigue. At the present time I take Ritalin in the AM. I still work full time but have cut back and now longer do any radical surgeries.
I am due at the end of April to be re imaged. At that time I will ask my oncologist about Firmagon and off label impilimumab.
At some point as we have discussed I will write in regarding some of my off label medications metformin, Ritalin, and Crestor.
Continue the good work! You are a source of not only knowledge but inspiration.