Carboplatina - Lexicomp

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CARBOplatin (Lexi-Drugs Multinational)
ALERT: US Boxed Warning

Experienced physician:
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:
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:
Vomiting is a frequent drug-related side effect.
Hypersensitivity reactions:
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.
Brand Names: International

Actoplatin (ID, PH); Adcarb (LK); B-Platin (BR); Bagotanilo (MX); Balidon (CO); Biocarb (IN); Biovinate (PH); Biplatinex (VE); Blastocarb (CL, CR,
DO, GT, HN, NI, PA, RU, SV); Blastocarb RU (MX); Bobei (CN); Bocartin (VN); Bopacatin (SK); Boplatex (CR, DO, GT, HN, NI, PA, SV); Carbaccord
(NZ); Carbol (ZW); Carbomedac (DE); Carbopa (MY); Carboplat (AR, BD, MX); Carboplatin (AE, CY, DK, IL, JO, KW, LB, LT, NO, PL, SA);
Carboplatin a (PT); Carboplatin Abic (TH); Carboplatin DBL (MY); Carboplatin dbl (PT); Carboplatin “Delta West” (HR); Carboplatin-David Bull
(LU); Carboplatin-Medac (LU); Carboplatin-Teva (HU); Carboplatino (CU); Carboplatinum Cytosafe-Delta West (LU); Carbosin (BE, GR, ID, KR,
LU, PH, ZA, ZW); Carbotera (RU); Carbotin (BD); Carbotinol (PH, SA); Carcan (ID); Carplan (KR); Caxatin (TW); Cobalmin (PE); Cycloplatin (CZ,
HU); Cytocarb (EG, LB); Delta West Carboplatin (PH); Kemocarb (EG, JO, LK, MX, PH, SG, TH, TW, VN, ZW); Megaplatin (LB); Naprolat (ZW);
Naproplat (PH); Neocarb (IN); Neoplatin (KR); Novoplatinum (PT); Nuvaplast (CR, DO, GT, HN, NI, PA, SV); Omilipis (AR, PY); Oncocarb (PE);
Oncocarbin (IN); Oncoplatin (BR); P&U Carboplatin (ZA); Paracy (RU); Paraplatin (AT, BG, BR, CH, EC, EE, EG, ES, FR, GB, HK, HN, HR, HU, IE, IT,
JO, LU, NL, PH, RU, SE, TR, TW, UY); Pharmaplatin (PK); Unicarb (LK); Vancel (PY); Womaplat (LK); Womastin (LK)
International Nonproprietary Names (INN)

Carboplatin [English]; Carboplatine [French]; Carboplatino [Spanish]; Carboplatinum [Latin]; Карбоплатин [Russian]; ‫[ ﻛﺎرﺑوﺑﻼﺗﯾن‬Arabic]; 卡铂
[Chinese]
Brazilian Nonproprietary Names (DCB)

Carboplatina
Japanese Accepted Name (JAN)

カルボプラチン
Anatomic Therapeutic Chemical (ATC) Classification

L01XA02
Pharmacologic Category
Antineoplastic Agent, Alkylating Agent; Antineoplastic Agent, Platinum Analog
Dosing: Adult
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
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).
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Bladder cancer
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
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
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
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
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
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).
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Gastric cancer
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
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
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
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
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
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
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
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).
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Neuroendocrine tumors, advanced, atypical or poorly differentiated, nonpulmonary
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
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
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
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)
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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
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
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
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
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
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
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
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).
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Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult
drug interactions database for more information.
* See Dosage and Administration in AHFS Essentials for additional information.
Dosing: Older Adult

The Calvert formula should be used to calculate dosing for elderly patients. Refer to adult dosing.
Dosing: Altered Kidney Function: Adult

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.
Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, carboplatin undergoes minimal hepatic metabolism
therefore dosage adjustment may not be needed.
Dosing: Obesity: Adult

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]).
Dosing: Adjustment for Toxicity: Adult

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.
Dosing: Chemotherapy Regimens

Bladder cancer: Carboplatin-Gemcitabine (Bladder)
Bone sarcoma (Ewing sarcoma): Ifosfamide-Carboplatin-Etoposide (Ewing Sarcoma)
Bone sarcoma (osteosarcoma): Ifosfamide-Carboplatin-Etoposide (Osteosarcoma)
Breast cancer:
Carboplatin-Docetaxel-Trastuzumab (Breast)
Carboplatin-Paclitaxel-Trastuzumab (Breast)
Pembrolizumab-Gemcitabine-Carboplatin (Breast)
Cervical cancer:
Carboplatin-Paclitaxel (Cervical Cancer)
Pembrolizumab-Paclitaxel-Carboplatin-Bevacizumab (Cervical)
Pembrolizumab-Paclitaxel-Carboplatin (Cervical)
Endometrial cancer: Carboplatin-Paclitaxel (Endometrial)
Esophageal cancer: Paclitaxel-Carboplatin (Esophageal)
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Head and neck cancer:
Carboplatin-Cetuximab (Head and Neck Cancer)
Carboplatin-Fluorouracil (Head and Neck)
Cetuximab-Carboplatin-Fluorouracil (Head and Neck Cancer)
Docetaxel-Cisplatin-Fluorouracil (Head and Neck)
Lung cancer (non-small cell):
Atezolizumab-Bevacizumab-Carboplatin-Paclitaxel (NSCLC)
Atezolizumab-Carboplatin-Paclitaxel (Protein Bound) (NSCLC)
Bevacizumab-Carboplatin-Paclitaxel (NSCLC)
Bevacizumab-Carboplatin-Pemetrexed (NSCLC)
Carboplatin-Gemcitabine (NSCLC)
Carboplatin-Paclitaxel (NSCLC)
Carboplatin-Paclitaxel-Pembrolizumab (NSCLC)
Carboplatin-Paclitaxel (Protein Bound) (NSCLC)
Carboplatin-Paclitaxel (Protein Bound)-Pembrolizumab (NSCLC)
Carboplatin-Pemetrexed (NSCLC)
Carboplatin-Pemetrexed-Pembrolizumab (NSCLC)
EC (NSCLC)
Lung cancer (small cell):
Atezolizumab-Carboplatin-Etoposide (Small Cell Lung Cancer)
Carboplatin-Etoposide (Small Cell Lung Cancer)
Carboplatin-Irinotecan (Small Cell Lung Cancer)
Lymphoma, Hodgkin:
Gemcitabine-Dexamethasone-Carboplatin (Hodgkin)
ICE (Hodgkin)
Lymphoma, non-Hodgkin (DLBCL):
R-ICE (NHL-DLBCL)
Rituximab-Gemcitabine-Dexamethasone-Carboplatin (NHL-DLBCL)
Malignant pleural mesothelioma: Carboplatin-Pemetrexed (Mesothelioma)
Ovarian cancer:
Bevacizumab-Carboplatin-Doxorubicin (Liposomal) (Ovarian)
Bevacizumab-Carboplatin-Gemcitabine (Ovarian)
Bevacizumab-Carboplatin-Paclitaxel (Ovarian)
Carboplatin-Docetaxel (Ovarian)
Carboplatin-Doxorubicin (Liposomal) (Ovarian)
Carboplatin-Etoposide (Ovarian Germ Cell Tumor)
Carboplatin-Gemcitabine (Ovarian)
Carboplatin-Paclitaxel (Ovarian)
Thymoma/Thymic carcinoma: Carboplatin-Paclitaxel (Thymoma/Thymic)
Unknown primary, adenocarcinoma:
Carboplatin-Docetaxel (Unknown Primary, Adenocarcinoma)
Carboplatin-Etoposide-Paclitaxel (Unknown Primary, Adenocarcinoma)
Carboplatin-Paclitaxel (Unknown Primary, Adenocarcinoma)
Unknown primary, squamous cell: Carboplatin-Docetaxel (Unknown Primary, Squamous Cell)
Dosing: Pediatric
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:
Modified Calvert Formulas
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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
Total dose (mg) = Target AUC x [uncorrected or raw GFR (mL/minute) + (0.36 x kg body weight)]
(Newell 1993)
Mann/Pein formula
Total dose (mg) = Target AUC x [uncorrected or raw GFR (mL/minute) + (15 x BSA(m2))]
(Mann 1998; Mann 2000; Pein 1998)
Marina/St. Jude formulaB

Dose (mg/m2) = Target AUC x [(0.93 x corrected GFR normalized to patient’s BSA (mL/minute/m2 )) + 15]
(Allen 2010; Marina 1993)
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)
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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
Dosing: Altered Kidney Function: Pediatric

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
Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, carboplatin undergoes minimal hepatic metabolism;
dosage adjustment may not be needed.
Calculations
Body Surface Area (Du Bois Method)
Body Surface Area (Gehan & George Method)
Body Surface Area (Mosteller Method)
Calvert Formula
Creatinine Clearance by Cockcroft-Gault
Creatinine Clearance by Cockcroft-Gault (SI units)
Creatinine Clearance by Cockcroft-Gault with IBW
Creatinine Clearance by Cockcroft-Gault with IBW (SI units)
Creatinine Clearance by Jelliffe
Creatinine Clearance by Sanaka
Glomerular Filtration Rate by Abbreviated MDRD
Glomerular Filtration Rate by Abbreviated MDRD (SI units)
Glomerular Filtration Rate by MDRD
Glomerular Filtration Rate by MDRD (IDMS-Traceable SCr)
Glomerular Filtration Rate by MDRD (SI units)
Glomerular Filtration Rate by Schwartz
Glomerular Filtration Rate Estimate in African Americans by AASK Equation
Use: Labeled Indications

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.
* See Uses in AHFS Essentials for additional information.
Use: Off-Label: Adult

Anal cancer (advanced) Level of Evidence [B]
Data from a multicenter, international, randomized, phase 2 study support the use of carboplatin (in combination with
conventional paclitaxel) for the treatment of advanced anal cancer in patients who had not received prior therapy for advanced
disease (Ref). Data from a small, retrospective study also support the use of carboplatin (in combination with paclitaxel) for the
treatment of advanced anal cancer (Ref).
Bladder cancer Level of Evidence [B]
Data from a phase 2 study and a phase 2/3 study support the use of carboplatin (in combination with gemcitabine) in patients with
advanced bladder cancer who are ineligible to receive cisplatin (Ref). Data from a phase 3 trial support the use of 4 to 6 cycles of
first-line carboplatin (in combination with gemcitabine) followed by avelumab maintenance therapy (plus best supportive care) in
patients with locally advanced unresectable or metastatic urothelial cancer that had not progressed after the 4 to 6 cycles of first-
line platinum-based chemotherapy (Ref).
Breast cancer (advanced or metastatic) Level of Evidence [A]
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Data from 2 multicenter, randomized phase 3 studies support the use of carboplatin (in combination with docetaxel and
trastuzumab or with paclitaxel and trastuzumab) in the treatment of HER-2 overexpressing metastatic breast cancer (Ref). Data
from 2 phase 2 studies also support the use of carboplatin in combination with docetaxel and trastuzumab for the treatment of
HER2-positive advanced or metastatic breast cancer (Ref). Data from a multicenter, randomized phase 2 study support the use of
carboplatin (in combination with paclitaxel [protein bound]) for first-line treatment of metastatic triple-negative breast cancer (Ref).
Data from a phase 2 and a phase 3 trial support the use of carboplatin (as a single agent) in the treatment of metastatic or locally
recurrent unresectable triple-negative breast cancer, particularly in patients with germline BRCA1/2 mutations (Ref). Data from 2
multicenter phase 2 trials support the use of carboplatin (in combination with paclitaxel) for the treatment of advanced or
metastatic breast cancer (Ref). Data from a randomized, double-blind, placebo-controlled, multicenter phase 3 trial (Keynote-355)
support the use of chemotherapy (including the regimen of carboplatin and gemcitabine) in combination with pembrolizumab for
the treatment of locally recurrent inoperable or metastatic triple-negative breast cancer (Ref).
Breast cancer (neoadjuvant/adjuvant therapy) Level of Evidence [A]
Data from a randomized, double-blind, multicenter, placebo-controlled phase 3 trial support the use of carboplatin (in combination
with paclitaxel, followed by 4 cycles of doxorubicin and cyclophosphamide) as neoadjuvant therapy for patients with operable high-
risk, triple-negative breast cancer (Ref). Data from a combined analysis of 2 study cohorts also support the use of carboplatin (in
combination with docetaxel) in the neoadjuvant treatment of invasive triple-negative breast cancer (Ref). Data from a large
multicenter, phase 3 trial support the use of carboplatin (in combination with docetaxel and trastuzumab; TCH regimen) as
adjuvant therapy in patients with HER2-positive early-stage, invasive, high-risk, node-negative or -positive breast cancer (Ref). Data
from a multicenter, open-label phase 2 trial support the use of carboplatin (in combination with trastuzumab, pertuzumab, and
docetaxel; TCHP regimen) as neoadjuvant therapy in patients with HER2-positive early breast cancer (Ref).
Cervical cancer (recurrent or metastatic) Level of Evidence [A, G]
Data from 3 studies support the use of carboplatin (in combination with paclitaxel or as a single agent) in the treatment of
advanced/metastatic or recurrent cervical cancer (Ref). In a phase 3 randomized trial, carboplatin (in combination with paclitaxel)
was found to be noninferior to cisplatin plus paclitaxel in the treatment of metastatic or recurrent cervical cancer, and may be a
reasonable option when cisplatin may be poorly tolerated or in patients previously treated with cisplatin (Ref). Data from a single-
arm phase 2 trial support the use of carboplatin (in combination with paclitaxel and bevacizumab) in the treatment of metastatic,
recurrent, or persistent cervical cancer not amenable to curative surgery and/or radiotherapy (Ref). Data from a double-blind phase
3 trial support the use of carboplatin (in combination with pembrolizumab and paclitaxel [conventional] ± bevacizumab) for the
treatment of persistent, recurrent, or metastatic cervical cancer (Ref).
Based on the American Society of Clinical Oncology management and care of patients with invasive cervical cancer resource-
stratified clinical practice guideline (as well as a rapid communication update), carboplatin (in combination with pembrolizumab
and paclitaxel [conventional] ± bevacizumab) may be offered as upfront therapy for eligible patients with persistent, recurrent, or
metastatic cervical carcinoma (± individualized radiation therapy and/or palliative care) in enhanced and maximal resource settings
(Ref). Additionally, carboplatin (either as a single agent or in combination with paclitaxel) may be utilized for the treatment of
invasive cervical cancer in limited resource settings (Ref).
Endometrial cancer (advanced or recurrent) Level of Evidence [A]
Data from several studies support the use of carboplatin (in combination with paclitaxel) in the treatment of advanced/metastatic
or recurrent endometrial cancer (Ref). Data from a small randomized, controlled phase 2 study support the use of carboplatin (in
combination with paclitaxel and trastuzumab) for the treatment of advanced (stage III or IV) or recurrent, HER2-positive
endometrial (uterine serous) cancer (Ref). Data from a randomized phase 2 trial suggest that carboplatin (in combination with
paclitaxel and bevacizumab) may be used in advanced or recurrent endometrial cancer (Ref).
Esophageal cancer Level of Evidence [A]
Data from a phase 3 trial support the use of carboplatin (in combination with paclitaxel and radiation) as preoperative
chemoradiotherapy for the treatment of esophageal or esophagogastric junction cancer (Ref). Data from two phase 2 studies also
support the use of carboplatin (in combination with paclitaxel) in the treatment of esophageal cancer (Ref).
Gastric cancer Level of Evidence [A]
Data from a phase 3 trial support the use of carboplatin (in combination with paclitaxel and radiation) as preoperative
chemoradiotherapy for the treatment of esophageal or esophagogastric junction cancer (Ref). A small phase 2 study also suggests
that carboplatin (in combination with paclitaxel) is an active and well-tolerated regimen in patients with advanced gastric cancer
(Ref).
Gestational trophoblastic neoplasia, high-risk, refractory Level of Evidence [C, G]
https://online.lexi.com/lco/action/doc/retrieve/docid/multinat_f/4669262?cesid=0G5Z3aZX1Pz&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%… 10/29
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Data from a small, prospective study support the use of carboplatin (in combination with paclitaxel) in the treatment for high-risk
gestational trophoblastic neoplasia refractory to frontline methotrexate-containing regimens (Ref). Data from small reports support
the use of carboplatin (in combination with ifosfamide, mesna, and etoposide [ICE regimen]) in patients with high-risk refractory
gestational trophoblastic neoplasia (GTN) (Ref).
Based on guidelines from the Society of Gynecologic Oncology of Canada and the Society of Obstetricians and Gynaecologists of
Canada, the ICE regimen (carboplatin in combination with ifosfamide, mesna and etoposide) is a treatment option for high-risk
GTN (Ref).
Head and neck cancer Level of Evidence [A]
Data from a phase 3 randomized study support the use of carboplatin (in combination with fluorouracil) for the treatment of
advanced squamous cell head and neck cancer (Ref). Data from a phase 3 randomized study support the use of carboplatin (in
combination with fluorouracil and cetuximab) as first-line treatment of recurrent or metastatic squamous cell head and neck
cancer (Ref). Data from a phase 2 study support the use of carboplatin (in combination with paclitaxel) in the treatment of advanced
head and neck cancer (Ref). Data from a phase 2 study support the use of carboplatin (in combination with cetuximab) in the
treatment of recurrent or metastatic nasopharyngeal cancer (Ref). Data from randomized phase 3 trials support the use of weekly
carboplatin (in combination with radiation) following induction chemotherapy with docetaxel, cisplatin, and fluorouracil for the
treatment of advanced head and neck cancer (Ref). Data from a randomized phase 3 study support the use of carboplatin (in
combination with fluorouracil and pembrolizumab) as initial treatment of recurrent or metastatic squamous cell carcinoma of the
head and neck (Ref).
Hematopoietic stem cell transplant for metastatic germ cell tumors Level of Evidence [C]
Data from a retrospective study suggest that carboplatin (in combination with etoposide) followed by autologous stem cell
transplant may be beneficial for the treatment of metastatic testicular germ cell cancer (Ref). Data from a phase 1/2 trial support
the use of high-dose carboplatin and etoposide (following paclitaxel and ifosfamide; TI-CE regimen) with stem cell support for
salvage treatment of progressive advanced germ cell tumors (Ref).
Hodgkin lymphoma (relapsed or refractory) Level of Evidence [B]
Data from a study of multimodality therapy in chemosensitive Hodgkin lymphoma support the use of carboplatin (in combination
with ifosfamide and etoposide, followed by autologous stem cell transplant) as salvage treatment of relapsed and refractory
Hodgkin lymphoma (Ref). Data from a small phase 2 trial in relapsed/refractory lymphoma (including Hodgkin lymphoma) support
the use of carboplatin (in combination with gemcitabine and dexamethasone) as salvage treatment for Hodgkin lymphoma (Ref).
Malignant pleural mesothelioma Level of Evidence [B, G]
Data from two phase 2 studies support the use of carboplatin (in combination with pemetrexed) in the treatment of advanced or
unresectable malignant pleural mesothelioma (MPM) (Ref). Data from an international expanded access program also support the
use of carboplatin (in combination with pemetrexed) for the treatment of unresectable MPM (Ref).
Based on the American Society of Clinical Oncology guidelines for MPM, pemetrexed plus platinum is the recommended first-line
therapy for unresectable MPM; carboplatin may be offered as a substitute for cisplatin in patients who are unable to tolerate
cisplatin (Ref).
Melanoma (advanced or metastatic) Level of Evidence [B]
Data from a large, phase 3 study support the use of carboplatin (in combination with conventional paclitaxel) for treatment of
metastatic melanoma if cytotoxic chemotherapy is indicated (Ref). Data from a retrospective review suggest that carboplatin (in
combination with paclitaxel) may be beneficial as a second-line regimen for the treatment of advanced or metastatic melanoma
(Ref).
Merkel cell carcinoma Level of Evidence [B]
Data from a phase 2 study in patients with high-risk Merkel cell carcinoma of the skin suggest that synchronous radiation in
combination with carboplatin and etoposide chemotherapy results in high levels of locoregional and distant control, as well as
survival (Ref). Data from another small study supports the use of weekly carboplatin administered concurrently with radiation,
followed by combination chemotherapy with carboplatin and etoposide after radiation completion for the treatment of Merkel cell
carcinoma with high-risk features (Ref).
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Neuroendocrine tumors, advanced, atypical or poorly differentiated (nonpulmonary) Level of Evidence [C, G]
Clinical data and consensus guideline recommendations from the North American Neuroendocrine Tumor Society (NANETS)
suggest that regimens active in the treatment of small cell lung cancer (eg, carboplatin, etoposide) may be effective for the
management of atypical or poorly differentiated (nonpulmonary) neuroendocrine tumors (Ref).
Non-Hodgkin lymphomas (relapsed or refractory) Level of Evidence [B]
Data from a small study support the use of carboplatin (in combination with rituximab, ifosfamide, and etoposide) as second-line
therapy to induce a response in the treatment of relapsed or refractory diffuse large B-cell lymphoma prior to autologous stem cell
transplant (Ref). Data from a small phase 2 trial in relapsed/refractory lymphoma (including non-Hodgkin lymphoma) support the
use of carboplatin (in combination with gemcitabine and dexamethasone ± rituximab) as salvage treatment for non-Hodgkin
lymphoma (Ref).
Non–small cell lung cancer Level of Evidence [A, G]
Data from a large randomized phase 3 study support the use of carboplatin (in combination with paclitaxel and bevacizumab) in
recurrent or advanced non-squamous non–small cell lung cancer (NSCLC) (Ref). Data from a subset analysis support the use of
carboplatin (in combination with paclitaxel) in elderly patients with advanced NSCLC (Ref). Data from a large randomized study
support the use of carboplatin (in combination with paclitaxel) in the adjuvant treatment of NSCLC in patients with tumors ≥4 cm
(Ref). Data from a multicenter randomized phase 3 trial support the use of carboplatin (in combination with docetaxel) for the
treatment of advanced NSCLC (Ref). Data from a large randomized phase 3 study support the use of carboplatin (in combination
with gemcitabine or pemetrexed) as first-line therapy in advanced NSCLC (Ref). Data from a large double-blind, randomized, phase
3 study and from a multicenter randomized phase 2 study support the use of carboplatin (in combination with pemetrexed and
pembrolizumab) in the management of previously untreated advanced (stage IIIB or IV) non-squamous NSCLC without EGFR
mutations or anaplastic lymphoma kinase (ALK) translocations (Ref). Data from a randomized phase 2 study support the use of
carboplatin (in combination with radiation therapy and paclitaxel) in the treatment of locally advanced NSCLC (Ref). Data from a
multicenter, randomized phase 3 trial support the use of carboplatin (in combination with paclitaxel [protein bound]) as first-line
therapy for advanced NSCLC (Ref). Another large phase 3 study supports the use of carboplatin (in combination with bevacizumab
and pemetrexed) for the treatment of advanced non-squamous NSCLC (Ref). Data from another randomized phase 3 study support
the use of carboplatin (in combination with atezolizumab, bevacizumab, and paclitaxel) as first-line treatment of metastatic NSCLC
or recurrent metastatic non-squamous NSCLC (previously untreated with chemotherapy) in patients without eGFR or ALK genomic
tumor alterations or with eGFR or ALK alterations and disease progression on or intolerance to a tyrosine kinase inhibitor (Ref).
Data from a large double-blind randomized phase 3 trial support the use of carboplatin (in combination with pembrolizumab and
either paclitaxel or paclitaxel [protein bound]) as first-line treatment of metastatic squamous cell NSCLC (Ref). Data from a large
multicenter randomized phase 3 trial support the use of carboplatin (in combination with atezolizumab and paclitaxel [protein
bound]) as first-line treatment of metastatic non-squamous cell NSCLC in patients without ALK or eGFR genomic tumor alterations
(Ref). Data from a large, multicenter, open-label phase 3 trial support the use of carboplatin (in combination with nivolumab,
ipilimumab and either paclitaxel or pemetrexed as first-line treatment of advanced NSCLC (Ref).
Based on the American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario; CCO) guidelines for therapy
for stage IV NSCLC without driver mutations, carboplatin may be a treatment option for patients with a performance status of 1 or
0 (refer to guidelines for details). Patients with non–squamous cell (non-SCC) NSCLC and high PD-L1 expression may be offered a
carboplatin-containing chemotherapy regimen in combination with immunotherapy (either pembrolizumab or
atezolizumab/bevacizumab). Patients with non-SCC NSCLC with negative or low PD-L1 expression should be offered carboplatin,
pemetrexed and pembrolizumab, or carboplatin plus a paclitaxel product and atezolizumab ± bevacizumab. Patients with
squamous cell NSCLC and high or negative/low PD-L1 expression may be offered carboplatin plus a paclitaxel product and
pembrolizumab. Patients with non-SCC or squamous cell NSCLC with negative or low PD-L1 expression with contraindications to
immunotherapy should be offered a platinum (doublet) therapy as recommended in the ASCO 2015 Stage IV NSCLC guideline (Ref).
The ASCO/CCO guidelines for therapy for stage IV NSCLC with driver mutations suggest carboplatin as a component of standard
therapy or doublet chemotherapy (with or without bevacizumab) may be offered in certain situations as outlined in the ASCO/CCO
guidelines for therapy for stage IV NSCLC in nondriver mutations; refer to guidelines for details (Ref).
Prostate cancer, castration-resistant, metastatic Level of Evidence [B]
Data from a phase 1/2 trial support the use of carboplatin (in combination with cabazitaxel) in the treatment of metastatic
castration-resistant prostate cancer, particularly in aggressive variant prostate cancer (Ref). Data from a small phase 2 study
support the use of carboplatin (in combination with docetaxel) for first-line treatment of metastatic prostate cancer that is
castration-resistant and has at least 1 anaplastic feature or is small-cell variant (Ref). Data from a small prospective study in patients
with castration-resistant prostate cancer with disease progression after docetaxel-based chemotherapy suggest carboplatin (in
combination with etoposide) may have activity in the treatment of this condition (Ref).
Sarcomas (Ewing sarcoma and osteosarcoma) Level of Evidence [B]
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Data from a study in patients ≤22 years of age with recurrent/refractory sarcomas (including Ewing and osteosarcoma), support
the use of carboplatin (in combination with ifosfamide and etoposide) as reinduction therapy in the treatment of this condition
(Ref).
Small cell lung cancer Level of Evidence [A, G]
Data from a randomized phase 3 study support the use of carboplatin (in combination with irinotecan) for the treatment of
extensive stage small cell lung cancer (SCLC) (Ref). Data from a randomized, double-blind, placebo-controlled phase 3 study support
the use of carboplatin (in combination with etoposide and atezolizumab) for the treatment of extensive-stage SCLC in previously
untreated patients (Ref). Data from a phase 2 study also support the use of carboplatin (in combination with irinotecan) for the
treatment of extensive stage SCLC (Ref). Data from an open-label phase 3 study support the use of carboplatin (in combination with
etoposide) in the treatment of extensive-stage SCLC (Ref). Data from a multicenter, open-label phase 3 trial support the use of
carboplatin (in combination with durvalumab and etoposide) for the first-line treatment of extensive-stage SCLC (Ref).
Data from a randomized phase 2 study support the use of carboplatin (in combination with etoposide and radiation therapy) for
the treatment of limited stage SCLC (Ref).
Data from a multicenter, randomized phase 3 study support the use of carboplatin (in combination with etoposide) for the
treatment of relapsed SCLC (originally diagnosed as limited or extensive stage disease) in patients who initially responded to first-
line platinum-based therapy (in combination with etoposide) with relapse or disease progression >90 days following completion of
first-line therapy. A significant improvement in progression-free survival with carboplatin and etoposide at relapse was also noted
in a subgroup analysis of patients with ≥6 months between first-line chemotherapy and progression (Ref).
Based on American Society of Clinical Oncology Guidelines for Treatment of Small-Cell Lung Cancer, platinum-based therapy in
combination with either etoposide or irinotecan is recommended over other chemotherapy regimens for limited stage or extensive
stage disease (Ref).
Testicular cancer (early stage, adjuvant therapy) Level of Evidence [A, G]
Data from a large randomized trial support the use of carboplatin (as a one-time dose) as adjuvant treatment of stage I seminoma
(Ref).
According to guidelines from the AUA, while adjuvant therapy with carboplatin is a treatment option and carboplatin may reduce
the risk of relapse following orchiectomy in stage I disease, active surveillance is the preferred alternative (in patients able to
comply with follow up) due to a lower risk for treatment-related morbidity (Ref).
Thymoma or thymic malignancies, advanced Level of Evidence [B]
Data from a multicenter phase 2 study support the use of carboplatin (in combination with paclitaxel) in the treatment of invasive,
recurrent, or metastatic thymoma or thymic carcinoma that is not amenable to curative surgery (Ref). Data from a multicenter
phase 2 trial support the use of carboplatin (in combination with paclitaxel) in the treatment of advanced thymic carcinoma not
previously treated with chemotherapy (Ref).
Thyroid carcinoma (anaplastic) Level of Evidence [B, G]
Data from a randomized phase 3 trial support the use of carboplatin (in combination with paclitaxel) for the treatment of advanced
or metastatic anaplastic thyroid carcinoma (Ref).
The American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer suggest that carboplatin
(in combination with paclitaxel) may be effective in the treatment of anaplastic thyroid carcinoma (either as
adjuvant/radiosensitizing therapy or in the management of advanced or metastatic disease) (Ref).
Unknown primary cancer Level of Evidence [B]
Data from a multicenter phase 2 study support the use of carboplatin (in combination with paclitaxel) in the treatment of
metastatic unknown primary adenocarcinoma (Ref). Data from a smaller phase 2 study also support the use of carboplatin (in
combination with docetaxel) in the management of metastatic unknown primary adenocarcinoma (Ref). Data from a prospective,
multicenter, phase 2 study in patients with metastatic poorly differentiated neuroendocrine carcinoma (62% with unknown primary
site) who had received no prior treatment demonstrated that carboplatin (in combination with paclitaxel and etoposide) is effective
for the management of cancer of unknown primary (Ref). Data from a multicenter phase 3 trial support the use of carboplatin (in
combination with paclitaxel and etoposide) in patients with previously untreated histologically documented carcinoma of unknown
primary site (Ref). Data from a small phase 2 trial support the use of carboplatin (in combination with irinotecan) in the treatment
of metastatic carcinoma of unknown primary (Ref).
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Level of Evidence Definitions

Level of Evidence Scale
A - Consistent evidence from well-performed randomized, controlled trials or overwhelming evidence of some other form (eg,
results of the introduction of penicillin treatment) to support the off-label use. Further research is unlikely to change
confidence in the estimate of benefit.
B - Evidence from randomized, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or
imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact
on confidence in the estimate of benefit and risk and may change the estimate.
C - Evidence from observational studies (eg, retrospective case series/reports providing significant impact on patient care),
unsystematic clinical experience, or from potentially flawed randomized, controlled trials (eg, when limited options exist for
condition). Any estimate of effect is uncertain.
G - Use has been substantiated by inclusion in at least one evidence-based or consensus-based clinical practice guideline.
Clinical Practice Guidelines

Obesity:
ASBMT, "Practice Guideline Committee Position Statement on Chemotherapy Dosing in Obesity," 2014
ASCO, "Appropriate Systemic Therapy Dosing for Obese Adult Patients with Cancer: ASCO Guideline Update," May 2021
Oncology:
ASCO, "Hepatitis B Virus Screening for Patients with Cancer Before Therapy, Provisional Clinical Opinion Update," July 2020
ASCO, “Management and Care of Patients With Invasive Cervical Cancer: ASCO Resource-Stratified Guideline Rapid Recommendation
Update,” March 2022
ASCO, “Management and Care of Women With Invasive Cervical Cancer: Resource-Stratified Clinical Practice Guideline,” May 2016
ASCO, "Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer, Practice Guideline Update," August 2015
ASCO, “Treatment of Malignant Pleural Mesothelioma: Clinical Practice Guideline,” January 2018
ASCO/ASCRO/SSO, "Management of Hereditary Breast Cancer," June 2020
ASCO/CCO, “Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update,”
February 2021
ASCO/CCO, “Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update,”
January 2020
ASCO Endorsement of the American College of Chest Physicians Guideline, "Treatment of Small-Cell Lung Cancer," September 2015
American Thyroid Association, “Guidelines for Management of Patients with Anaplastic Thyroid Cancer,” 2012
AUA, "Diagnosis and Treatment of Early Stage Testicular Cancer," May 2019
AUA/ASCO/ASTRO/SUO, "Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer," September 2017
EAU, "Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update," June 2020
EDF/EADO/EORTC, "Diagnosis and Treatment of Merkel Cell Carcinoma: European Consensus-Based Interdisciplinary Guideline - Update
2022," June 2022
GOC/SOGC, "Guideline No. 408: Management of Gestational Trophoblastic Diseases," January 2021
NANETS, “Consensus Guidelines for the Management and Treatment of Neuroendocrine Tumors,” 2013
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Anal Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” B-cell
Lymphomas
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Bladder
Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Bone Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Breast Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Central
Nervous System Cancers
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Cervical
Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Cutaneous
Melanoma
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Esophageal
and Esophagogastric Junction Cancers
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National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Gastric Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Gestational
Trophoblastic Neoplasia
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Head and
Neck Cancers
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Hodgkin
Lymphoma
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Malignant
Pleural Mesothelioma
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Merkel Cell
Carcinoma
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),”
Neuroendocrine Tumors
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Non-Small Cell
Lung Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Occult Primary
(Cancer of Unknown Primary [CUP])
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Ovarian
Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Prostate
Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Small Cell
Lung Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Testicular
Cancer
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Thymomas
and Thymic Carcinomas
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Thyroid
Carcinoma
National Comprehensive Cancer Network® (NCCN), "NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®),” Uterine
Neoplasms
Society of Gynecologic Oncology (SGO)/ASCO, "Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer," August
2016
Oncology Antiemesis:
ASCO, "Antiemetics: Clinical Practice Guideline Update," July 2020
Multinational Association of Supportive Care in Cancer (MASCC)/European Society for Medical Oncology (ESMO), “Antiemetic
Guidelines,” Updated 2019
Administration: IV
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]).
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.
Administration: Pediatric
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.
Vesicant/Extravasation Risk
May be an irritant
Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 1]).
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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).
Storage/Stability
Store intact vials at room temperature at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light. Further dilution
to a concentration as low as 0.5 mg/mL is stable at room temperature (25°C) for 8 hours in NS or D5W. Stability has also been demonstrated
for dilutions in D5W in PVC bags at room temperature for 9 days (Benaji 1994) and for dilutions (0.5 mg/mL, 2 mg/mL, and 4 mg/mL) in NS in
PVC bags at room temperature for 24 hours, 24 hours, and 2 days, respectively (Myers 2016); however, the manufacturer recommends use
within 8 hours due to lack of preservative. Multidose vials are stable for up to 14 or 15 days after opening when stored at 25°C (77°F)
following multiple needle entries (refer to specific product labeling for stability information). Follow USP 797 recommendations for beyond
use dates based on the level of risk for preparation.
Preparation for Administration: Adult

Solution for injection: Manufacturer's labeling states solution can be further diluted to concentrations as low as 0.5 mg/mL in NS or D5W;
however, most clinicians generally dilute dose in either 100 mL or 250 mL of NS or D5W.
Concentrations used for desensitization vary based on protocol.
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.
Preparation for Administration: Pediatric

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.
Parenteral: IV: Solution for injection: Manufacturer's labeling states solution can be further diluted to concentrations as low as 0.5 mg/mL in
NS or D5W; in adults, doses are generally diluted in either 100 mL or 250 mL of NS or D5W.
Concentrations used for desensitization vary based on protocol.
Compatibility
See Trissel’s IV Compatibility Database
Abrir a compatibilidade intravenosa do Trissel
Medication Safety Issues

Sound-alike/look-alike issues:
CARBOplatin may be confused with CISplatin, oxaliplatin

Paraplatin may be confused with Platinol
High alert medication:
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.
Contraindications
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.
Warnings/Precautions
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).
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• 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.
* See Cautions in AHFS Essentials for additional information.
Older Adult Considerations

Peripheral neuropathy and severe thrombocytopenia are more frequent in patients >65 years of age.
Warnings: Additional Pediatric Considerations

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).
Reproductive Considerations
Women of childbearing potential should avoid becoming pregnant during treatment
Pregnancy Considerations
Carboplatin may cause fetal harm if administered during pregnancy.
Breastfeeding Considerations
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.
Briggs' Drugs in Pregnancy & Lactation

Carboplatin
Adverse Reactions
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%)
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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)
* See Cautions in AHFS Essentials for additional information.
Allergy and Idiosyncratic Reactions

Platinum Derivative Allergy
Oncology: Emetic Potential

Pediatrics: ≥175 mg/m2/dose: High (>90%).
Adults:
AUC ≥4: High (>90%).
AUC <4: Moderate (30% to 90%).
Metabolism/Transport Effects
None known.
Drug Interactions
Abrir Interações
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
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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 vaccine at least 28 days after the primary vaccine
dose. Patients should also receive 2 booster doses of mRNA vaccine - one 2 months after the 2nd (additional) dose and another 4
months after the first booster dose. 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 based on the brand of mRNA vaccine received. 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
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
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
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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 post-exposure rabies
vaccination is required during immunosuppressant therapy, administer a 5th dose of vaccine and check for rabies antibodies. 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).
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).
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): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated).
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
Genes of Interest
Excision Repair Cross-Complementing Rodent Repair Deficiency, Complementation Group 1 (Includes Overlapping Antisense Sequence)
Excision Repair Cross-Complementing Rodent Repair Deficiency, Complementation Group 2
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Monitoring Parameters
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.
Advanced Practitioners Physical Assessment/Monitoring

Assess patient allergy history prior to therapy and note specific use cautions (eg, bone marrow suppression and renal function). Assess other
drugs patient may be taking for potential interactions (especially products that may be ototoxic or nephrotoxic and need for sequencing with
taxane derivatives). Assess hematology, electrolytes, and renal and hepatic function tests prior to treatment and on a regular basis during
therapy. Monitor for nausea and vomiting (pretreatment with antiemetic may be required), ototoxicity (audiometry may be advisable), bone
marrow depression, anemia, bleeding, and peripheral neuropathy.
Nursing Physical Assessment/Monitoring

Patient allergy history must be assessed prior to therapy. Assess other drugs patient may be taking for potential interactions (especially
products that may be ototoxic or nephrotoxic and need for sequencing with taxane derivatives). Assess hematology, electrolytes, and renal
and hepatic function tests prior to treatment and on a regular basis during therapy. Monitor for nausea and vomiting (pretreatment with
antiemetic may be required), ototoxicity (audiometry may be advisable), bone marrow depression, anemia, bleeding, and peripheral
neuropathy.
Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
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); 150 mg/15 mL (15 mL); 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)
Dosage Forms: Canada

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)
Generic Available (US)

Yes
Pricing: US
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)
50 mg/5 mL (per mL): $3.17
150 mg/15 mL (per mL): $1.83
450 mg/45 mL (per mL): $1.73
600 mg/60 mL (per mL): $1.43
1000 mg/100 mL (per mL): $1.41
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided
when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the
range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any
prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span
expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price
or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages
arising from use of price or price range data. Pricing data is updated monthly.
Mechanism of Action
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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.
Pharmacokinetics
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)
Pharmacokinetics: Additional Considerations

Altered kidney function: In patients with CrCl <60 mL/minute, the total body and renal clearance decreases as CrCl decreases.
Dental: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions
Dental: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Stomatitis, mucositis, and taste dysgeusia.
Dental: Effects on Bleeding

Hemorrhagic complication (ie, bleeding) has been reported in 5% of patients. Thrombocytopenia is one of the dose-limiting complications of
carboplatin's myelosuppression. A medical consult is suggested.
Related Information
Common Toxicity Criteria
Desensitization Protocols
Management of Chemotherapy-Induced Nausea and Vomiting in Adults
Management of Drug Extravasations
Prevention of Chemotherapy-Induced Nausea and Vomiting in Children
Safe Handling of Hazardous Drugs
Index Terms
CBDCA; Paraplatin
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Brand Names: US
Paraplatin
Last Updated 8/9/22
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Carboplatina - Lexicomp

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Carboplatina - Lexicomp

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18/08/2022 Lexicomp

CARBOplatin (Lexi-Drugs Multinational)

ALERT: US Boxed Warning

Bone marrow suppression:

Vomiting is a frequent drug-related side effect.

Brand Names: International

International Nonproprietary Names (INN)

Brazilian Nonproprietary Names (DCB)

Japanese Accepted Name (JAN)

Anatomic Therapeutic Chemical (ATC) Classification

Anal cancer, advanced

Breast cancer, advanced or metastatic

Breast cancer, neoadjuvant/adjuvant therapy

Breast cancer, neoadjuvant/adjuvant therapy (off-label use):

Cervical cancer, recurrent or metastatic

Endometrial cancer, advanced or recurrent

Gestational trophoblastic neoplasia, high-risk, refractory

Gestational trophoblastic neoplasia, high-risk, refractory (off-label use):

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

Non–small cell lung cancer (off-label use):

Ovarian cancer, advanced

Ovarian cancer, advanced:

Prostate cancer, castration-resistant, metastatic

Small cell lung cancer

Small cell lung cancer (off-label use):

Testicular cancer, early stage, adjuvant treatment

Thymoma or thymic malignancies, advanced

Thyroid carcinoma, anaplastic

Thyroid carcinoma, anaplastic (off-label use):

Unknown primary cancer

Dosing: Older Adult

Dosing: Altered Kidney Function: Adult

Dosing: Hepatic Impairment: Adult

Dosing: Obesity: Adult

Dosing: Adjustment for Toxicity: Adult

Dosing: Chemotherapy Regimens

Modified Calvert Formulas

Marina/St. Jude formulaB

Dosing: Altered Kidney Function: Pediatric

Dosing: Hepatic Impairment: Pediatric

Use: Labeled Indications

Use: Off-Label: Adult

Bladder cancer Level of Evidence [B]

Breast cancer (advanced or metastatic) Level of Evidence [A]

Breast cancer (neoadjuvant/adjuvant therapy) Level of Evidence [A]

Cervical cancer (recurrent or metastatic) Level of Evidence [A, G]

Endometrial cancer (advanced or recurrent) Level of Evidence [A]

Esophageal cancer Level of Evidence [A]

Gastric cancer Level of Evidence [A]

Gestational trophoblastic neoplasia, high-risk, refractory Level of Evidence [C, G]

Head and neck cancer Level of Evidence [A]

Hodgkin lymphoma (relapsed or refractory) Level of Evidence [B]

Malignant pleural mesothelioma Level of Evidence [B, G]

Melanoma (advanced or metastatic) Level of Evidence [B]

Merkel cell carcinoma Level of Evidence [B]

Non-Hodgkin lymphomas (relapsed or refractory) Level of Evidence [B]