Carboplatin should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Appropriate management of therapy and complications is possible only when adequate treatment facilities are readily available.
Bone marrow suppression is dose related and may be severe, resulting in infection or bleeding. Anemia may be cumulative and may require transfusion support.
Vomiting is a frequent drug-related side effect.
Anaphylactic-like reactions to carboplatin have been reported and may occur within minutes of carboplatin administration. Epinephrine, corticosteroids, and antihistamines have been employed to alleviate symptoms.
Note: Doses for adults are commonly calculated by the Target AUC using the Calvert formula, where Total dose (mg) = Target AUC x (GFR + 25). If estimating GFR instead of a measured GFR, the FDA recommends that clinicians consider capping estimated GFR at a maximum of 125 mL/minute to avoid potential toxicity. Antiemetics may be recommended to prevent nausea and vomiting; carboplatin is associated with a moderate or high emetic potential (dose/AUC dependent) (ASCO [Hesketh 2020]; MASCC/ESMO [Roila 2016]).
Anal cancer, advanced (off-label use): IV: Target AUC 5 on day 1 every 4 weeks (in combination with paclitaxel) for 6 cycles or until disease progression or unacceptable toxicity (Rao 2020) or Target AUC 5 or 6 every 3 weeks (in combination with paclitaxel) (Kim 2014).
Bladder cancer (off-label use): IV: Target AUC 5 on day 1 every 3 weeks (in combination with gemcitabine) for 6 cycles unless disease progression or unacceptable toxicity occurred; may continue beyond 6 cycles if clinical benefit (Bamias 2006) or Target AUC 4.5 on day 1 every 3 weeks (in combination with gemcitabine) until disease progression or unacceptable toxicity (De Santis 2012).
First-line carboplatin (in combination with gemcitabine; doses not specified) for 4 to 6 cycles, followed by maintenance avelumab + best supportive care (BSC) significantly prolonged overall survival (compared to BSC alone) in unresectable locally advanced or metastatic urothelial cancer that had not progressed following the first-line platinum-based chemotherapy (Powles 2020).
Breast cancer, advanced or metastatic (off-label use): IV: Target AUC 6 on day 2 every 3 weeks (in combination with trastuzumab and paclitaxel) for at least 6 cycles, followed by trastuzumab monotherapy (Robert 2006) or Target AUC 6 on day 1 or day 2 every 3 weeks (in combination with trastuzumab and docetaxel) for 6 or 8 cycles, followed by trastuzumab monotherapy (Pegram 2004; Valero 2011) or Target AUC 6 every 3 weeks (in combination with paclitaxel) until disease progression or unacceptable toxicity (Perez 2000) or Target AUC 2 on days 1, 8, and 15 every 4 weeks (in combination with weekly paclitaxel) until disease progression or unacceptable toxicity (Loesch 2002).
Triple-negative advanced or metastatic breast cancer: IV: Target AUC 2 on days 1 and 8 every 3 weeks (in combination with gemcitabine and pembrolizumab); refer to protocol for details (Cortes 2020) or Target AUC 2 on days 1 and 8 every 3 weeks (in combination with paclitaxel [protein bound]) until disease progression or unacceptable toxicity (Yardley 2018) or Target AUC 6 (as a single agent) every 3 weeks until disease progression or unacceptable toxicity (Isakoff 2015) or Target AUC 6 (as a single agent) every 3 weeks for 6 cycles; if responding to and tolerating treatment, may receive an additional 2 cycles per local policy (Tutt 2018).
Breast cancer, neoadjuvant/adjuvant therapy (off-label use):
Triple-negative breast cancer (neoadjuvant): IV: Target AUC 6 on day 1 every 3 weeks (in combination with weekly paclitaxel) for 4 cycles, followed by 4 cycles of doxorubicin and cyclophosphamide, followed by surgery (Loibl 2018) or Target AUC 6 every 3 weeks (in combination with docetaxel and WBC growth factor support) for 6 cycles (Sharma 2017; Sharma 2018).
TCHP regimen (neoadjuvant; HER2-positive): IV: Target AUC 6 every 3 weeks (in combination with trastuzumab, pertuzumab, and docetaxel) for 6 cycles, followed by surgery along with trastuzumab monotherapy to complete 1 year of trastuzumab therapy (Schneeweiss 2013).
TCH regimen (adjuvant; HER2-positive): IV: Target AUC 6 every 3 weeks (in combination with docetaxel and trastuzumab) for 6 cycles, followed by trastuzumab monotherapy to complete 52 weeks of therapy (Slamon 2011).
Cervical cancer, recurrent or metastatic (off-label use): IV: Target AUC 5 every 3 weeks (in combination with paclitaxel) for 6 to 9 cycles (Pectasides 2009) or Target AUC 5 to 6 on day 1 every 4 weeks (in combination with paclitaxel) for 6 to 9 cycles (Tinker 2005) or 400 mg/m2 on day 1 every 28 days (as a single agent) (Weiss 1990) or Target AUC 5 on day 1 every 3 weeks on day 1 (in combination with paclitaxel) until disease progression or unacceptable toxicity (Kitagawa 2015) or Target AUC 5 on day 1 every 3 weeks (in combination with paclitaxel and bevacizumab) until disease progression or unacceptable toxicity (Redondo 2020) or Target AUC 5 on day 1 every 3 weeks (in combination with pembrolizumab and paclitaxel [conventional] ± bevacizumab) for 6 cycles; patients could continue chemotherapy beyond 6 cycles if experiencing clinical benefit without unacceptable toxicity; refer to protocol for further information (Colombo 2021).
Endometrial cancer, advanced or recurrent (off-label use): IV: Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) for up to 7 cycles (Miller 2020) or Target AUC 5 every 3 weeks (in combination with paclitaxel) for 6 to 9 cycles or until disease progression or unacceptable toxicity (Pectasides 2008) or Target AUC 2 on days 1, 8, and 15 every 28 days (in combination with paclitaxel) until disease progression or unacceptable toxicity (Secord 2007) or Target AUC 5 on day 1 every 3 weeks (in combination with paclitaxel and bevacizumab) for 6 to 8 cycles, followed by bevacizumab maintenance; refer to protocol for further information (Lorusso 2019) or (for HER2+ uterine serous cancer) Target AUC 5 every 3 weeks (in combination with paclitaxel and trastuzumab) for ~6 cycles, followed by trastuzumab maintenance therapy (Fader 2018).
Esophageal cancer (off-label use): IV: Target AUC 2 once weekly for 5 weeks (in combination with paclitaxel and radiation therapy) prior to surgery (van Hagen 2012; van Meerten 2006) or Target AUC 5 every 3 weeks (in combination with paclitaxel) (El-Rayes 2004).
Gastric cancer (off-label use): IV: Target AUC 2 once weekly for 5 weeks (in combination with paclitaxel and concurrent radiation) prior to surgery (van Hagen 2012) or Target AUC 5 to 6 every 3 weeks (in combination with paclitaxel) (Gadgeel 2003).
Gestational trophoblastic neoplasia, high-risk, refractory (off-label use):
Carboplatin/paclitaxel regimen: IV: Target AUC 6 once every 3 weeks (in combination with paclitaxel); continue for 2 treatment cycles after an undetectable hCG level (Rathod 2015).
ICE regimen: IV: Target AUC 4 on day 1 every 3 weeks (in combination with ifosfamide, mesna, etoposide and pegfilgrastim or filgrastim); continue for at least 2 treatment cycles after a normal hCG level (Lurain 2010; Lurain 2012).
Head and neck cancer (off-label use): IV: Target AUC 5 on day 1 every 3 weeks (in combination with cetuximab) until disease progression or unacceptable toxicity or a maximum of 8 cycles (Chan 2005) or Target AUC 5 on day 1 every 3 weeks (in combination with cetuximab and fluorouracil) for up to 6 cycles (Vermorken 2008) or 300 mg/m2 on day 1 every 4 weeks (in combination with fluorouracil) (Forastiere 1992) or Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) until disease progression or unacceptable toxicity (Clark 2001) or Target AUC 1.5 weekly for 7 weeks (in combination with radiation, following 3 cycles of docetaxel, cisplatin, and fluorouracil [TPF] induction therapy [begin carboplatin/radiation therapy 3 to 8 weeks after the start of TPF cycle 3]) (Haddad 2013; Posner 2007) or Target AUC 5 every 3 weeks (in combination with fluorouracil and pembrolizumab) for 6 cycles, followed by up to 24 months of pembrolizumab monotherapy (Burtness 2019).
Hematopoietic stem cell transplant for metastatic germ cell tumors (off-label use):
EC regimen: IV: 700 mg/m2/day for 3 days beginning 5 days prior to peripheral stem cell infusion (in combination with etoposide) for 2 cycles (Einhorn 2007).
TI-CE regimen: IV: Target AUC 7 to 8 (in combination with etoposide) on days 1 to 3 followed by autologous stem cell support every 21 to 28 days for 3 cycles (cycles 3 to 5). Cycles 1 and 2 consisted of paclitaxel, ifosfamide, and mesna. Refer to protocol for further information (Feldman 2010).
Hodgkin lymphoma, relapsed or refractory (off-label use): IV: Target AUC 5 (maximum dose: 800 mg) on day 2 every 2 weeks (in combination with ifosfamide and etoposide) for 2 cycles (Moskowitz 2001) or Target AUC 5 on day 1 (in combination with gemcitabine and dexamethasone) every 3 weeks for up to 4 cycles (Gopal 2010).
Malignant pleural mesothelioma (off-label use): IV: Target AUC 5 on day 1 every 3 weeks (in combination with pemetrexed) (Ceresoli 2006) or Target AUC 5 on day 1 every 3 weeks (in combination with pemetrexed) until disease progression, unacceptable toxicity, or for a maximum of 9 cycles (Castagneto 2008) or Target AUC 5 on day 1 every 3 weeks (in combination with pemetrexed) until disease progression or unacceptable toxicity (Santoro 2008).
Melanoma, advanced or metastatic (off-label use; if cytotoxic chemotherapy is indicated): IV: Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) for 4 cycles followed by (if dose not previously reduced) Target AUC 5 on day 1 every 3 weeks (in combination with paclitaxel) for up to 6 additional cycles (Flaherty 2013) or Target AUC 2 on days 1, 8, and 15 every 4 weeks (in combination with paclitaxel) (Rao 2006).
Merkel cell carcinoma (off-label use): IV: Target AUC 4.5 on day 1 of weeks 1, 4, 7, and 10 (in combination with etoposide and synchronous radiation therapy) (Poulsen 2003) or Target AUC 2 on day 1 weekly for up to 5 doses (administered concurrently with radiation), followed (beginning 3 weeks after radiation therapy) by carboplatin with a Target AUC of 4.5 on day 1 (in combination with etoposide) every 3 weeks for 3 cycles (Poulsen 2008).
Neuroendocrine tumors, advanced, atypical or poorly differentiated, nonpulmonary (off-label use): IV: Target AUC 6 on day 1 every 3 weeks (in combination with etoposide) for 4 to 6 cycles (NANETS [Strosberg 2010]; Skarlos 2001).
Non-Hodgkin lymphomas, relapsed or refractory (off-label use): IV: Target AUC 5 (maximum dose: 800 mg) every ~2 weeks for 3 cycles (in combination with rituximab, ifosfamide, and etoposide) (Kewalramani 2004) or Target AUC 5 on day 1 (in combination with gemcitabine and dexamethasone ± rituximab) every 3 weeks for up to 4 cycles (Gopal 2010).
Non–small cell lung cancer (off-label use):
Nonsquamous cell histology: IV: Target AUC 6 on day 1 every 3 weeks for 4 to 6 cycles (in combination with atezolizumab, bevacizumab, and paclitaxel) followed by atezolizumab/bevacizumab maintenance therapy (Socinski 2018) or Target AUC 6 every 3 weeks for 4 to 6 cycles (in combination with atezolizumab and paclitaxel [protein bound]) followed by atezolizumab maintenance therapy (West 2019) or Target AUC 5 or 6 every 3 weeks (in combination with pemetrexed, nivolumab, and ipilimumab) for 2 cycles; nivolumab/ipilimumab therapy continued until disease progression, unacceptable toxicity, or for up to 2 years in patients without disease progression (Paz-Ares 2021) or Target AUC 6 on day 1 every 3 weeks (in combination with pemetrexed and bevacizumab) for up to 4 cycles followed by maintenance therapy (Patel 2013) or Target AUC 5 every 3 weeks (in combination with pemetrexed and pembrolizumab) for 4 cycles followed by pembrolizumab/pemetrexed maintenance therapy (Gandhi 2018; Langer 2016) or Target AUC 6 on day 1 every 3 weeks (in combination with bevacizumab and paclitaxel) for 6 cycles in the absence of disease progression or unacceptable toxicity (Sandler 2006).
Squamous cell histology: IV: Target AUC 6 on day 1 every 3 weeks for 4 cycles (in combination with pembrolizumab and either paclitaxel or paclitaxel [protein bound]) followed by pembrolizumab maintenance therapy (Paz-Ares 2018) or Target AUC 6 every 3 weeks (in combination with paclitaxel, nivolumab, and ipilimumab) for 2 cycles; nivolumab/ipilimumab therapy continued until disease progression, unacceptable toxicity, or for up to 2 years in patients without disease progression (Paz-Ares 2021).
Nonsquamous or squamous cell histology: IV: Target AUC 6 on day 1 every 4 weeks (in combination with paclitaxel) for up to 4 cycles (Ramalingam 2008) or Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) for 4 cycles (Strauss 2008) or Target AUC 5 on day 1 every 3 weeks (in combination with pemetrexed or gemcitabine) for up to 4 cycles (Gronberg 2009) or Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel [protein bound]) for at least 6 cycles or until disease progression or unacceptable toxicity (Socinski 2012) or Target AUC 6 on day 1 every 3 weeks (in combination with docetaxel) for at least 6 cycles or until disease progression or unacceptable toxicity (Fossella 2003) or Target AUC 2 every week for 7 weeks, then Target AUC 6 every 3 weeks for 2 consolidation cycles (in combination with paclitaxel and radiation therapy) (Belani 2005).
Ovarian cancer, advanced:
Advanced ovarian cancer (off-label dosing): IV: Target AUC 5 to 7.5 on day 1 every 3 weeks (in combination with paclitaxel) (Ozols 2003; Parmar 2003) or Target AUC 5 or 6 on day 1 every 3 weeks (in combination with paclitaxel) for 6 cycles (Clamp 2019) or Target AUC 2 once weekly (in combination with weekly paclitaxel) for 18 consecutive weeks (Clamp 2019; Pignata 2014) or Target AUC 5 every 3 weeks (in combination with docetaxel) (Vasey 2004) or Target AUC 6 on day 1 every 3 weeks (in combination with bevacizumab [delayed until cycle 2] and paclitaxel) for up to 6 cycles, followed by bevacizumab monotherapy for a total of up to 22 cycles or until disease progression (whichever occurs earlier) (Burger 2011) or Target AUC 5 on day 1 every 4 weeks (in combination with doxorubicin [liposomal]) for at least 6 cycles (Pujade-Lauriane 2010) or Target AUC 5 on day 1 every 4 weeks (in combination with doxorubicin [liposomal] and bevacizumab) for up to 6 cycles, followed by bevacizumab maintenance; refer to protocol for further information (Pfisterer 2020) or Target AUC 4 on day 1 every 3 weeks (in combination with gemcitabine and bevacizumab) for 6 to 10 cycles, followed by bevacizumab maintenance (Aghajanian 2012).
Neoadjuvant therapy (off-label schedule): Note: According to guidelines from the Society of Gynecologic Oncology (SGO) and American Society of Clinical Oncology (ASCO) for neoadjuvant chemotherapy in newly diagnosed advanced ovarian cancer, neoadjuvant therapy should be utilized only in properly selected patients. Selection criteria include patients with newly diagnosed suspected stage IIIC or IV ovarian cancer who have a high perioperative risk profile and/or a low likelihood of achieving cytoreduction to <1 cm of residual disease (SGO/ASCO [Wright 2016]).
IV: Target AUC 5 or 6 on day 1 every 3 weeks (either as a single agent or in combination with paclitaxel) for 3 neoadjuvant cycles, followed by debulking surgery, followed by 3 additional chemotherapy cycles (Kehoe 2015) or Target AUC 5 on day 1 every 3 weeks (in combination with paclitaxel) for 3 neoadjuvant cycles, followed by debulking surgery, followed by 3 additional chemotherapy cycles (Vergote 2010) or Target AUC 5 on day 1 every 3 weeks (in combination with paclitaxel) for 3 to 4 neoadjuvant cycles, followed by debulking surgery, followed by 2 to 3 additional chemotherapy cycles, for a total of 6 cycles (Fagotti 2016) or Target AUC 5 or 6 on day 1 every 3 weeks (in combination with paclitaxel) for a total of 6 cycles, with debulking surgery occurring after cycles 3 to 6 (Clamp 2019) or Target AUC 2 on days 1, 8, and 15 every 3 weeks (in combination with paclitaxel) for a total of 6 cycles, with debulking surgery occurring after cycles 3 to 6 (Clamp 2019).
Malignant germ cell tumor (off-label dosing): IV: 400 mg/m2 on day 1 (in combination with etoposide) every 4 weeks for 3 cycles (Williams 2004).
Manufacturer's labeling: IV: Dosing in the prescribing information may not reflect current clinical practice. 360 mg/m2 every 4 weeks (as a single agent) or 300 mg/m2 every 4 weeks (in combination with cyclophosphamide) for 6 cycles or Target AUC 4 to 6 (single agent; in previously treated patients).
Prostate cancer, castration-resistant, metastatic (off-label use): IV: Target AUC 4 on day 1 every 3 weeks (in combination with cabazitaxel, growth factor support, and prednisone) until disease progression or unacceptable toxicity for up to 10 cycles (Corn 2019) or Target AUC 5 on day 1 every 3 weeks (in combination with docetaxel) for at least 4 cycles or until disease progression or unacceptable toxicity (Aparicio 2013) or Target AUC 5 on day 1 every 3 weeks (in combination with etoposide) until disease progression or unacceptable toxicity (Loriot 2009).
Sarcomas (Ewing sarcoma, osteosarcoma) (off-label uses): Adults ≤22 years of age: IV: 400 mg/m2/day for 2 days every 21 days (in combination with ifosfamide and etoposide) (van Winkle 2005).
Small cell lung cancer (off-label use):
Extensive stage disease: IV: Target AUC 5 on day 1 every 3 weeks (in combination with etoposide) for up to 6 cycles (Socinski 2009) or Target AUC 5 on day 1 every 3 weeks (in combination with irinotecan) for up to 4 cycles (Hermes 2008) or Target AUC 5 on day 1 every 28 days (in combination with irinotecan) for 2 to 6 cycles (Schmittel 2006) or Target AUC 5 on day 1 every 3 weeks (in combination with etoposide and atezolizumab) for 4 induction cycles, followed by atezolizumab maintenance therapy (Horn 2018) or Target AUC 5 or 6 on day 1 every 3 weeks (in combination with etoposide and durvalumab) for 4 cycles, followed by durvalumab maintenance therapy until disease progression or unacceptable toxicity (Paz-Ares 2019).
Limited stage disease: IV: Target AUC 6 on day 1 every 3 weeks (in combination with etoposide) for up to 6 cycles (Skarlos 2001).
Relapsed disease (diagnosed initially as limited or extensive stage): IV: Target AUC 5 on day 1 every 3 weeks (in combination with etoposide) for a maximum of 6 cycles (Baize 2020).
Testicular cancer, early stage, adjuvant treatment (off-label use): IV: Target AUC 7 as a single, one-time dose (Oliver 2011).
Thymoma or thymic malignancies, advanced (off-label use): IV: Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) for up to 6 cycles (Hirai 2015; Lemma 2011).
Thyroid carcinoma, anaplastic (off-label use):
Adjuvant or radiosensitizing therapy: IV: Target AUC 2 once weekly (in combination with weekly paclitaxel) (ATA [Smallridge 2012]).
Advanced or metastatic disease: IV: Target AUC 5 to 6 on day 1 every 3 weeks (in combination with paclitaxel) for 6 cycles (ATA [Smallridge 2012]; Sosa 2014) or Target AUC 2 once weekly (in combination with weekly paclitaxel) (ATA [Smallridge 2012]).
Unknown primary cancer (off-label use): IV: Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel) for up to 8 cycles (Briasoulis 2000) or Target AUC 6 on day 1 every 3 weeks (in combination with docetaxel) for up to 8 cycles (Greco 2000) or Target AUC 6 on day 1 every 3 weeks (in combination with paclitaxel and etoposide) for 2 to 4 cycles, followed by paclitaxel monotherapy (in patients with objective response or stable disease) (Hainsworth 2006), or for a minimum of 4 and a maximum of 6 cycles (Hainsworth 2010) or Target AUC 5 on day 1 every 4 weeks (in combination with irinotecan) for up to 6 cycles (Yonemori 2009).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Note: Dose determination with Calvert formula uses GFR and, therefore, inherently adjusts for kidney dysfunction.
The manufacturer's labeling recommends the following dosage adjustments for single-agent therapy:
Baseline CrCl 41 to 59 mL/minute: Initiate at 250 mg/m2 and adjust subsequent doses based on bone marrow toxicity.
Baseline CrCl 16 to 40 mL/minute: Initiate at 200 mg/m2 and adjust subsequent doses based on bone marrow toxicity.
Baseline CrCl ≤15 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.
The following dosage adjustments have also been recommended:
Aronoff 2007:
Note: For dosing based on mg/m2:
GFR >50 mL/minute: No dosage adjustment is necessary.
GFR 10 to 50 mL/minute: Administer 50% of the usual dose.
GFR <10 mL/minute: Administer 25% of the usual dose.
Hemodialysis: Administer 50% of the usual dose.
Continuous ambulatory peritoneal dialysis (CAPD): Administer 25% of the usual dose.
Continuous renal replacement therapy (CRRT): 200 mg/m2.
Janus 2010, Krens 2019: Hemodialysis: Carboplatin dose (mg) = Target AUC x 25; administer on a nondialysis day, hemodialysis should occur between 12 to 24 hours after carboplatin dose.
There are no dosage adjustments provided in the manufacturer's labeling; however, carboplatin undergoes minimal hepatic metabolism therefore dosage adjustment may not be needed.
(For additional information see "Carboplatin: Pediatric drug information")
Note: Dosing and frequency may vary by protocol and/or treatment phase; refer to specific protocol. In pediatric patients, dosing may be based on either BSA (mg/m2), weight (mg/kg), or a modified Calvert formula calculation (mg); use extra precaution to verify dosing parameters and units of GFR/estimated CrCl during calculations, as errors can lead to significant over/under dosing. Some protocols suggest weight or age cut-offs for weight-based (mg/kg) dosing; refer to specific protocol. Carboplatin is associated with a high emetic potential in pediatric patients (POGO [Paw Cho Sing 2019]); antiemetics are recommended to prevent nausea and vomiting.
Calvert Formula, modified: Limited data available; multiple formulas have been used; formula may be protocol-specific (Liem 2003): Some protocols may calculate pediatric carboplatin doses using one of the following modified Calvert formulas:
|
Target AUC: Protocol specific dependent upon indication; value presented in terms of mg/mL and minute units (eg, mg/mL/minute or mg/mL•minute are frequently reported). Note: Ensure appropriate GFR valueA is used for calculation and resulting carboplatin dose (mg or mg/m2) units. | |
|
Newell formula (Newell 1993) |
Total dose (mg) = Target AUC x [uncorrected or raw GFR (mL/minute) + (0.36 x kg body weight)] |
|
Mann/Pein formula (Mann 1998; Mann 2000; Pein 1998) |
Total dose (mg) = Target AUC x [uncorrected or raw GFR (mL/minute) + (15 x BSA(m2))] |
|
Marina/St. Jude formulaB (Allen 2010; Marina 1993) |
Dose (mg/m2) = Target AUC x [(0.93 x corrected GFR normalized to patient’s BSA (mL/minute/m2 )) + 15] |
|
AGFR definitions: Raw GFR = uncorrected GFR = mL/minute Normalized GFR = corrected GFR = mL/minute/1.73 m2 BMarina/St. Jude formula: Uses a corrected GFR normalized to patient’s BSA (mL/minute/m2); converting GFR to this may be done as follows: Corrected GFR (mL/minute/1.73 m2)/1.73 = GFR (mL/minute/m2) Uncorrected GFR (mL/minute)/patient’s BSA = GFR (mL/minute/m2) | |
Note: Calvert formula was based on using chromic edetate (51Cr-EDTA) plasma clearance to establish GFR. This or 99mTc- DTPA nuclear medicine GFR study is preferred over estimating CrCl per Schwartz equation as CrCl theoretically exceeds measured GFR by >12% in subjects with normal renal function (Allen 2010) (see Warnings/Precautions for additional information).
Hematopoietic stem cell transplant (HSCT): Limited data available:
Cohen 2015: Consolidation with myeloablative chemotherapy: Infants ≥6 months and Children ≤3 years: IV: 17 mg/kg over 2 hours on days 0 and 1 of a 21-day cycle in combination with thiotepa for 3 cycles.
Gilheeney 2010, Kushner 2001: Myeloablative: Children and Adolescents: IV: ~500 mg/m2 over 4 hours for 3 doses on days -5 to -3; dosing utilized Calvert formula with a target AUC=7 in combination regimen with thiotepa and topotecan
Spreafico 2008: Consolidation after reinduction chemo (relapsed Wilms Tumor): Children <12 years: IV: 200 mg/m2 for 4 doses on days -6 to -3 in combination with melphalan and etoposide
Glioma: Limited data available (Packer 1997): Infants ≥3 months, Children, and Adolescents:
Induction: IV: 175 mg/m2 once weekly for 4 weeks every 6 weeks (2-week recovery period between courses) in combination with vincristine for 2 cycles
Maintenance: IV: 175 mg/m2 weekly for 4 weeks, with a 3-week recovery period between courses in combination with vincristine for ≤12 cycles
Neuroblastoma, localized and unresectable: Limited data available:
Infants: IV: 6.6 mg/kg on days 1, 2, and 3 in combinations with etoposide for 2 cycles (CE regimen), followed by cyclophosphamide, doxorubicin, and vincristine (CAdO regimen) (Rubie 2001)
Children <10 kg: IV: 100 to 140 mg/m2/day on days 1, 2, and 3 every 21 days in combination with etoposide for 2 cycles (CE regimen), followed by cyclophosphamide, doxorubicin, and vincristine (CAdO regimen) (Rubie 1998)
Children ≥10 kg and Adolescents: IV: 200 mg/m2/day on days 1, 2, and 3 every 21 days in combination with etoposide for 2 cycles (CE regimen), followed by cyclophosphamide, doxorubicin, and vincristine (CAdO regimen) (Rubie 1998)
Retinoblastoma: Limited data available:
Rodriguez-Galindo 2003: Infants and Children:
GFR ≥50 mL/minute/m2: IV: 560 mg/m2 in combination with vincristine every 21 days for 8 cycles
GFR <50 mL/minute/m2: IV: Dosing utilized modified Calvert formula with a target AUC=6.5 in combination regimen with vincristine every 21 days for 8 cycles
Friedman 2000:
Infants and Children ≤3 years: IV: 18.6 mg/kg on day 0 every 28 days in combination with etoposide and vincristine for 6 cycles (VEC regimen)
Children >3 years: IV: 560 mg/m2 on day 0 every 28 days in combination with etoposide and vincristine for 6 cycles (VEC regimen)
Sarcomas; Ewing sarcoma, osteosarcoma: Children and Adolescents: IV: 400 mg/m2/day for 2 days every 21 days in combination with ifosfamide and etoposide (ICE regimen) (Van Winkle 2005)
Wilms tumor, relapsed or refractory:
Abu-Ghosh 2002; Daw 2009: Children and Adolescents: IV: 400 mg/m2/day for 2 days or modified Calvert using Marina/St. Jude formula with a target AUC=6 for 1 day in combination with ifosfamide and etoposide every 21 days (ICE regimen)
Spreafico 2008: Reinduction prior to autologous stem cell rescue: Children <12 years: IV: 600 mg/m2 for 1 dose in combination with ifosfamide and etoposide
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Dosing adjustment for toxicity: The presented dosing adjustments are based on experience in adult patients; specific recommendations for pediatric patients are limited. Refer to specific protocol for management in pediatric patients if available.
Adult: Post-treatment nadir: Platelets <50,000 cells/mm3 or ANC <500 cells/mm3: Administer 75% of dose
Infants, Children, and Adolescents: The following dosage adjustments have been recommended (Aronoff 2007):
GFR >50 mL/minute/1.73 m2: No dosage adjustment necessary
GFR ≤50 mL/minute/1.73 m2: Use modified Calvert formula (see protocol for specific details) incorporating patient's GFR
Continuous renal replacement therapy (CRRT): Use modified Calvert formula (see protocol for specific details) incorporating GFR of 33 mL/minute
Hemodialysis, peritoneal dialysis: Use modified Calvert formula (see protocol for specific details) incorporating GFR <10 mL/minute
There are no dosage adjustments provided in the manufacturer's labeling; however, carboplatin undergoes minimal hepatic metabolism; dosage adjustment may not be needed.
The Calvert formula should be used to calculate dosing for elderly patients. Refer to adult dosing.
American Society of Clinical Oncology (ASCO) Guidelines for appropriate chemotherapy dosing in adults with cancer with a BMI ≥30 kg/m2 (excludes hematopoietic stem cell transplant dosing): Utilize patient's actual body weight (full weight) for calculation of body surface area (BSA)- or weight-based dosing, particularly when the intent of therapy is curative; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full weight-based dosing with subsequent cycles, if cause of toxicity (eg, hepatic or renal impairment) is clearly established and fully resolved and performance status has markedly improved (ASCO [Griggs 2021]).
American Society for Blood and Marrow Transplantation (ASBMT) practice guideline committee position statement on chemotherapy dosing in obesity: Utilize actual body weight (full weight) for calculation of BSA (when applicable) in carboplatin dosing for hematopoietic stem cell transplant conditioning regimens in adults. Based on the literature, there is no consensus for carboplatin dosing based on AUC in transplant conditioning regimens or dosing adjustments during transplant for obese patients (ASBMT [Bubalo 2014]).
Hematologic toxicity: In general, single-agent carboplatin cycles should be delayed until WBC and platelet counts have recovered.
Platelets <50,000 cells/mm3 or ANC <500 cells/mm3: Administer 75% of the usual dose.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Generic: 50 mg/5 mL (5 mL); 150 mg/15 mL (15 mL); 450 mg/45 mL (45 mL); 600 mg/60 mL (60 mL)
Solution, Intravenous [preservative free]:
Paraplatin: 50 mg/5 mL (5 mL [DSC]); 150 mg/15 mL (15 mL [DSC]); 450 mg/45 mL (45 mL); 600 mg/60 mL (60 mL); 1000 mg/100 mL (100 mL) [pyrogen free]
Generic: 50 mg/5 mL (5 mL); 150 mg/15 mL (15 mL); 450 mg/45 mL (45 mL); 600 mg/60 mL (60 mL)
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection:
Generic: 10 mg/mL (5 mL, 15 mL, 45 mL, 60 mL)
Antiemetics may be recommended to prevent nausea and vomiting; depending on the dose, carboplatin is associated with a moderate or high emetic potential in adults (ASCO [Hesketh 2020]; MASCC/ESMO [Roila 2016]).
IV: Infuse over at least 15 minutes; usually infused over 15 to 60 minutes, although some protocols may require infusions up to 24 hours. When administered as a part of a combination chemotherapy regimen, sequence of administration may vary by regimen; refer to specific protocol for sequence recommendation.
Needles or IV administration sets that contain aluminum should not be used in the preparation or administration of carboplatin; aluminum can react with carboplatin resulting in precipitate formation and loss of potency.
Carboplatin is associated with a high emetic potential in pediatric patients (POGO [Paw Cho Sing 2019]); antiemetics are recommended to prevent nausea and vomiting.
Parenteral: Note: Needles or IV administration sets that contain aluminum should not be used in the preparation or administration of carboplatin; aluminum can react with carboplatin resulting in precipitate formation and loss of potency.
IV: Administer over 15 to 60 minutes although some protocols may require infusions up to 24 hours. When administered as a part of a combination chemotherapy regimen, sequence of administration may vary by regimen; refer to specific protocol for sequence recommendation.
Hazardous agent (NIOSH 2016 [group 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).
Ovarian cancer, advanced: Initial treatment of advanced ovarian cancer in combination with other established chemotherapy agents; palliative treatment of recurrent ovarian cancer after prior chemotherapy, including cisplatin-based treatment.
Anal cancer (advanced); Bladder cancer; Breast cancer (advanced or metastatic); Breast cancer (neoadjuvant/adjuvant therapy); Cervical cancer (recurrent or metastatic); Endometrial cancer (advanced or recurrent); Esophageal cancer; Gastric cancer; Gestational trophoblastic neoplasia, high-risk, refractory; Head and neck cancer; Hematopoietic stem cell transplant for metastatic germ cell tumors; Hodgkin lymphoma (relapsed or refractory); Malignant pleural mesothelioma; Melanoma (advanced or metastatic); Merkel cell carcinoma; Neuroendocrine tumors, advanced, atypical or poorly differentiated (nonpulmonary); Non-Hodgkin lymphomas (relapsed or refractory); Non–small cell lung cancer; Prostate cancer, castration-resistant, metastatic; Sarcomas (Ewing sarcoma and osteosarcoma); Small cell lung cancer; Testicular cancer (early stage, adjuvant therapy); Thymoma or thymic malignancies, advanced; Thyroid carcinoma (anaplastic); Unknown primary cancer
CARBOplatin may be confused with CISplatin, oxaliplatin
Paraplatin may be confused with Platinol
This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults.
>10%:
Endocrine & metabolic: Decreased serum calcium (22% to 31%), decreased serum magnesium (29% to 43%), decreased serum potassium (20% to 28%), decreased serum sodium (29% to 47%)
Gastrointestinal: Gastrointestinal pain (17%), nausea (10% to 15%), nausea and vomiting (92%), vomiting (65% to 81%; severe vomiting: 22%)
Hematologic & oncologic: Anemia (21% to 90%), leukopenia (15% to 85%), neutropenia (16% to 67%), thrombocytopenia (25% to 62%)
Hepatic: Increased serum alkaline phosphatase (24% to 37%), increased serum aspartate aminotransferase (15% to 19%)
Nervous system: Asthenia (11%), pain (23%)
Renal: Decreased creatinine clearance (27%), increased blood urea nitrogen (14% to 22%)
1% to 10%:
Dermatologic: Alopecia (2% to 3%)
Gastrointestinal: Constipation (6%), diarrhea (6%), dysgeusia (1%), stomatitis (1%)
Hematologic & oncologic: Hemorrhage (5%; including iatrogenic bleeding)
Hepatic: Increased serum bilirubin (5%)
Hypersensitivity: Hypersensitivity reaction (2%)
Infection: Infection (5%)
Nervous system: Neurotoxicity (5%), peripheral neuropathy (4% to 6%)
Ophthalmic: Visual disturbance (1%)
Otic: Ototoxicity (1%)
Renal: Increased serum creatinine (6% to 10%)
Postmarketing:
Cardiovascular: Hypertension
Endocrine & metabolic: Dehydration
Gastrointestinal: Anorexia
Hematologic & oncologic: Febrile neutropenia, hemolytic-uremic syndrome
Hypersensitivity: Anaphylaxis (Horita 2021)
Local: Injection site reaction (erythema at injection site, pain at the infection site, swelling at injection site)
Nervous system: Malaise
Ophthalmic: Papilledema (hemorrhagic) (Santos-Bueso 2019)
Renal: Acute interstitial nephritis (Asai 2020)
History of severe allergic reaction to carboplatin, cisplatin, other platinum-containing formulations, or any component of the formulation; should not be used in patients with severe bone marrow depression or significant bleeding.
Canadian labeling: Additional contraindications (not in the US labeling): Preexisting severe renal impairment.
Concerns related to adverse effects:
• Bone marrow suppression: Bone marrow suppression, which may be severe, is dose related; may result in infection (due to neutropenia) or bleeding (due to thrombocytopenia). Anemia (which is cumulative) may require blood transfusion. The median nadir typically occurs at day 21 for single-agent carboplatin. Patients who have received prior myelosuppressive therapy and patients with renal dysfunction are at increased risk for bone marrow suppression.
• GI toxicity: Nausea and vomiting may occur; antiemetics may be recommended to prevent nausea and vomiting. Nausea and vomiting may be more severe in patients who have received prior emetogenic chemotherapy.
• Hepatic function abnormalities: High doses (>4 times the recommended dose) have resulted in severe abnormalities of LFTs.
• Hypersensitivity/anaphylactoid reactions: Anaphylactic-like reactions have been reported with carboplatin; may occur within minutes of administration. Epinephrine, corticosteroids, and antihistamines have been used to treat symptoms. The risk of allergic reactions (including anaphylaxis) is increased in patients previously exposed to platinum therapy. Skin testing and desensitization protocols have been reported (Confina-Cohen 2005; Lee 2004; Markman 2003).
• Neurotoxicity: Although peripheral neuropathy occurs infrequently, the incidence of peripheral neuropathy is increased in patients >65 years of age and those who have previously received cisplatin treatment.
• Ototoxicity: Ototoxicity may occur when administered concomitantly with aminoglycosides. Clinically significant hearing loss has been reported to occur in pediatric patients when therapy was administered at higher-than-recommended doses in combination with other ototoxic agents (eg, aminoglycosides). In a study of children receiving carboplatin for the treatment of retinoblastoma, those <6 months of age at treatment initiation were more likely to experience ototoxicity; long-term audiology monitoring is recommended (Qaddoumi 2012).
• Renal toxicity: Carboplatin has a limited potential for nephrotoxicity unless administered concomitantly with aminoglycosides. Use caution with concomitant administration with aminoglycosides or other nephrotoxic medications.
• Vision loss: Loss of vision (usually reversible within weeks of discontinuing) has been reported with higher-than-recommended doses.
Disease-related concerns:
• Renal impairment: Patients with renal dysfunction are at increased risk for bone marrow suppression.
Concurrent drug therapy issues:
• Taxane derivatives: When administered as sequential infusions, taxane derivatives (docetaxel, paclitaxel) should be administered before the platinum derivatives (carboplatin, cisplatin) to limit myelosuppression and to enhance efficacy.
Special populations:
• Older adult: Patients >65 years of age are more likely to develop thrombocytopenia (severe) and peripheral neuropathy.
Other warnings/precautions:
• Dosing with Calvert formula: When calculating the carboplatin dose using the Calvert formula and an eGFR, the laboratory method used to measure serum creatinine may impact dosing. Compared to other methods, standardized isotope dilution mass spectrometry (IDMS) may underestimate serum creatinine values in patients with low creatinine values (eg, ≤0.7 mg/dL) and may overestimate GFR in patients with normal renal function. This may result in higher calculated carboplatin doses and increased toxicities. If using IDMS, the FDA recommends that clinicians consider capping estimated GFR at a maximum of 125 mL/minute to avoid potential toxicity.
Ototoxicity has been reported with platinum-based (ie, cisplatin and carboplatin) chemotherapy; the reported incidence in pediatric patients with cisplatin is 13% to 95% and is highly variable due to different assessment tools, which also affects reported severity levels and risk factor determination. In a multicenter trial of 333 patients (mean age: 4 years; range: 0.3 to 29 years; 80% of patients were <5 years at time of diagnosis) treated for high-risk neuroblastoma with cisplatin induction therapy followed by an HSCT myeloablative regimen which included carboplatin in some patients (ie, multiple-exposure), audiological evaluations (including baseline) were completed using multiple assessment tools. At the time of evaluation, the majority of patients were <5 years of age at time of initial exposure and results showed some degree of hearing loss in ≥64% of patients following single exposure (cisplatin induction) and >80% of those with multiple-exposure (cisplatin induction plus carboplatin myeloablation) regardless of grading scale. Overall, the hearing loss was graded as moderate or severe in 41% to 85% of patients depending on the scale with a higher incidence (66% to 85%) in those with who received both cisplatin induction and carboplatin myeloablation; >50% required a hearing aid (Landier 2014).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Aminoglycosides: CARBOplatin may enhance the nephrotoxic effect of Aminoglycosides. Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Risk C: Monitor therapy
Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination
Bexarotene (Systemic): CARBOplatin may increase the serum concentration of Bexarotene (Systemic). Risk C: Monitor therapy
Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy
Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy
Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination
Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification
COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy
COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy
COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination
Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification
Desmopressin: Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy
Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination
Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination
Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Fosphenytoin-Phenytoin: Platinum Derivatives may decrease the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy
Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy
Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification
Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination
Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy
Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy
Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy
Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification
Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy
Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination
Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification
Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification
Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification
Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification
SORAfenib: May enhance the adverse/toxic effect of CARBOplatin. CARBOplatin may increase the serum concentration of SORAfenib. Management: Concurrent sorafenib with carboplatin and paclitaxel in patients with squamous cell lung cancer is contraindicated. Use in other settings is not specifically contraindicated but should be approached with added caution. Risk D: Consider therapy modification
Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy
Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination
Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination
Taxane Derivatives: Platinum Derivatives may enhance the myelosuppressive effect of Taxane Derivatives. Administer Taxane derivative before Platinum derivative when given as sequential infusions to limit toxicity. Management: Administer paclitaxel before cisplatin, when given as sequential infusions, to limit toxicity. Problems associated with other taxane/platinum combinations are possible, although unsubstantiated. Administering the taxane before platinum is likely warranted Risk D: Consider therapy modification
Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination
Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination
Topotecan: Platinum Derivatives may enhance the adverse/toxic effect of Topotecan. Management: Consider administering platinum derivatives after topotecan when possible to minimize toxicity or using lower doses if administering platinum derivatives prior to topotecan. Monitor for hematologic toxicity (eg, neutropenia, thrombocytopenia). Risk D: Consider therapy modification
Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination
Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination
Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination
Women of childbearing potential should avoid becoming pregnant during treatment
Carboplatin may cause fetal harm if administered during pregnancy.
It is not known if carboplatin is present in breast milk. Due to the potential for toxicity in the breastfed infant, the manufacturer recommends discontinuing breastfeeding during carboplatin treatment.
CBC (with differential and platelet count), serum electrolytes, serum creatinine and BUN, CrCl, LFTs; audiology evaluations (children <6 months of age); signs/symptoms of hypersensitivity reactions.
The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), total Ig or IgG, and antibody to hepatitis B surface antigen (anti-HBs) prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.
Carboplatin is a platinum compound alkylating agent which covalently binds to DNA; interferes with the function of DNA by producing interstrand DNA cross-links. Carboplatin is apparently not cell-cycle specific.
Distribution: Vd: 16 L (based on a dose of 300 to 500 mg/m2); into liver, kidney, skin, and tumor tissue
Protein binding: Carboplatin: 0%; Platinum (from carboplatin): Irreversibly binds to plasma proteins
Metabolism: Minimally hepatic to aquated and hydroxylated compounds
Half-life elimination: CrCl >60 mL/minute: Carboplatin: 2.6 to 5.9 hours (based on a dose of 300 to 500 mg/m2); Platinum (from carboplatin): ≥5 days
Excretion: Urine (~70% as carboplatin within 24 hours; 3% to 5% as platinum within 1 to 4 days)
Altered kidney function: In patients with CrCl <60 mL/minute, the total body and renal clearance decreases as CrCl decreases.
Solution (CARBOplatin Intravenous)
50 mg/5 mL (per mL): $1.98 - $3.22
150 mg/15 mL (per mL): $1.68 - $1.86
450 mg/45 mL (per mL): $1.14 - $1.73
600 mg/60 mL (per mL): $1.00 - $2.16
Solution (Paraplatin Intravenous)
450 mg/45 mL (per mL): $1.73
600 mg/60 mL (per mL): $1.43
1000 mg/100 mL (per mL): $1.41
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