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Carboplatin (Carboplatin) - Side Effects and Adverse Reactions

 
 



ADVERSE REACTIONS

For a comparison of toxicities when carboplatin or cisplatin was given in combination with cyclophosphamide, see CLINICAL STUDIES, Use with Cyclophosphamide for Initial Treatment of Ovarian Cancer, Comparative Toxicity.

ADVERSE EXPERIENCES IN PATIENTS WITH OVARIAN CANCER
First Line Combination Therapy 1
Percent
Second Line Single Agent Therapy 2
Percent
Bone Marrow
Thrombocytopenia <100,000/mm3 66 62
<50,000/mm3 33 35
Neutropenia <2,000 cells/mm3 96 67
<1,000 cells/mm3 82 21
Leukopenia <4,000 cells/mm3 97 85
<2,000 cells/mm3 71 26
Anemia <11 g/dL 90 90
<8g/dL 14 21
Infections 16 5
Bleeding 8 5
Transfusions 35 44
Gastrointestinal
Nausea and vomiting 93 92
Vomiting 83 81
Other GI side effects 46 21
Neurologic
Peripheral neuropathies 15 6
Ototoxicity 12 1
Other sensory side effects 5 1
Central neurotoxicity 26 5
Renal
Serum creatinine elevations 6 10
Blood urea elevations 17 22
Hepatic
Bilirubin elevations 5 5
SGOT elevations 20 19
Alkaline phosphatase elevations 29 37
Electrolytes loss
Sodium 10 47
Potassium 16 28
Calcium 16 31
Magnesium 61 43
Other side effects
Pain 44 23
Asthenia 41 11
Cardiovascular 19 6
Respiratory 10 6
Allergic 11 2
Genitourinary 10 2
Alopecia 49 2
Mucositis 8 1

1 Use with Cyclophosphamide for Initial Treatment of Ovarian Cancer: Data are based on the experience of 393 patients with ovarian cancer (regardless of baseline status) who received initial combination therapy with carboplatin and cyclophosphamide in two randomized controlled studies conducted by SWOG and NCIC (see CLINICAL STUDIES).
 
Combination with cyclophosphamide as well as duration of treatment may be responsible for the differences that can be noted in the adverse experience table.
2 Single Agent Use for the Secondary Treatment of Ovarian Cancer: Data are based on the experience of 553 patients with previously treated ovarian carcinoma (regardless of baseline status) who received single agent carboplatin.
 

In the narrative section that follows, the incidences of adverse events are based on data from 1,893 patients with various types of tumors who received carboplatin as single agent therapy.

Hematologic Toxicity

Bone marrow suppression is the dose-limiting toxicity of carboplatin. Thrombocytopenia with platelet counts below 50,000/mm3 occurs in 25% of the patients (35% of pretreated ovarian cancer patients); neutropenia with granulocyte counts below 1,000/mm3 occurs in 16% of the patients (21% of pretreated ovarian cancer patients); leukopenia with WBC counts below 2,000/mm3 occurs in 15% of the patients (26% of pretreated ovarian cancer patients). The nadir usually occurs about day 21 in patients receiving single agent therapy. By day 28, 90% of patients have platelet counts above 100,000/mm3; 74% have neutrophil counts above 2,000/mm3; 67% have leukocyte counts above 4,000/mm3.

Marrow suppression is usually more severe in patients with impaired kidney function. Patients with poor performance status have also experienced a higher incidence of severe leukopenia and thrombocytopenia.

The hematologic effects, although usually reversible, have resulted in infectious or hemorrhagic complications in 5% of the patients treated with carboplatin, with drug related death occurring in less than 1% of the patients. Fever has also been reported in patients with neutropenia.

Anemia with hemoglobin less than 11 g/dL has been observed in 71% of the patients who started therapy with a baseline above that value. The incidence of anemia increases with increasing exposure to carboplatin. Transfusions have been administered to 26% of the patients treated with carboplatin (44% of previously treated ovarian cancer patients).

Bone marrow depression may be more severe when carboplatin is combined with other bone marrow suppressing drugs or with radiotherapy.

Gastrointestinal Toxicity

Vomiting occurs in 65% of the patients (81% of previously treated ovarian cancer patients) and in about one-third of these patients it is severe. Carboplatin, as a single agent or in combination, is significantly less emetogenic than cisplatin; however, patients previously treated with emetogenic agents, especially cisplatin, appear to be more prone to vomiting. Nausea alone occurs in an additional 10% to 15% of patients. Both nausea and vomiting usually cease within 24 hours of treatment and are often responsive to antiemetic measures. Although no conclusive efficacy data exist with the following schedules, prolonged administration of carboplatin, either by continuous 24-hour infusion or by daily pulse doses given for 5 consecutive days, was associated with less severe vomiting than the single-dose intermittent schedule. Emesis was increased when carboplatin was used in combination with other emetogenic compounds. Other gastrointestinal effects observed frequently were pain, in 17% of the patients; diarrhea, in 6%; and constipation, also in 6%.

Neurologic Toxicity

Peripheral neuropathies have been observed in 4% of the patients receiving carboplatin (6% of pretreated ovarian cancer patients) with mild paresthesias occurring most frequently. Carboplatin therapy produces significantly fewer and less severe neurologic side effects than does therapy with cisplatin. However, patients older than 65 years and/or previously treated with cisplatin appear to have an increased risk (10%) for peripheral neuropathies. In 70% of the patients with pre-existing cisplatin-induced peripheral neurotoxicity, there was no worsening of symptoms during therapy with carboplatin. Clinical ototoxicity and other sensory abnormalities such as visual disturbances and change in taste have been reported in only 1% of the patients. Central nervous system symptoms have been reported in 5% of the patients and appear to be most often related to the use of antiemetics.

Although the overall incidence of peripheral neurologic side effects induced by carboplatin is low, prolonged treatment, particularly in cisplatin pretreated patients, may result in cumulative neurotoxicity.

Nephrotoxicity

Development of abnormal renal function test results is uncommon, despite the fact that carboplatin, unlike cisplatin, has usually been administered without high-volume fluid hydration and/or forced diuresis. The incidences of abnormal renal function tests reported are 6% for serum creatinine and 14% for blood urea nitrogen (10% and 22%, respectively, in pretreated ovarian cancer patients). Most of these reported abnormalities have been mild and about one-half of them were reversible.

Creatinine clearance has proven to be the most sensitive measure of kidney function in patients receiving carboplatin, and it appears to be the most useful test for correlating drug clearance and bone marrow suppression. Twenty-seven percent of the patients who had a baseline value of 60 mL/min or more demonstrated a reduction below this value during carboplatin therapy.

Hepatic Toxicity

The incidences of abnormal liver function tests in patients with normal baseline values were reported as follows: total bilirubin, 5%; SGOT, 15%; and alkaline phosphatase, 24%; (5%, 19%, and 37%, respectively, in pretreated ovarian cancer patients). These abnormalities have generally been mild and reversible in about one-half of the cases, although the role of metastatic tumor in the liver may complicate the assessment in many patients. In a limited series of patients receiving very high dosages of carboplatin and autologous bone marrow transplantation, severe abnormalities of liver function tests were reported.

Electrolyte Changes

The incidences of abnormally decreased serum electrolyte values reported were as follows: sodium, 29%; potassium, 20%; calcium, 22%; and magnesium, 29%; (47%, 28%, 31% and 43%, respectively, in pretreated ovarian cancer patients). Electrolyte supplementation was not routinely administered concomitantly with carboplatin, and these electrolyte abnormalities were rarely associated with symptoms.

Allergic Reactions

Hypersensitivity to carboplatin has been reported in 2% of the patients. These allergic reactions have been similar in nature and severity to those reported with other platinum-containing compounds, i.e., rash, urticaria, erythema, pruritus, and rarely bronchospasm and hypotension. Anaphylactic reactions have been reported as part of postmarketing surveillance (see WARNINGS). These reactions have been successfully managed with standard epinephrine, corticosteroid, and antihistamine therapy.

Injection Site Reactions

Injection site reactions, including redness, swelling, and pain, have been reported during postmarketing surveillance. Necrosis associated with extravasation has also been reported.

Other Events

Pain and asthenia were the most frequently reported miscellaneous adverse effects; their relationship to the tumor and to anemia was likely. Alopecia was reported (3%). Cardiovascular, respiratory, genitourinary, and mucosal side effects have occurred in 6% or less of the patients. Cardiovascular events (cardiac failure, embolism, cerebrovascular accidents) were fatal in less than 1% of the patients and did not appear to be related to chemotherapy. Cancer-associated hemolytic uremic syndrome has been reported rarely.

Malaise, anorexia, hypertension, dehydration, and stomatitis have been reported as part of postmarketing surveillance.



REPORTS OF SUSPECTED CARBOPLATIN SIDE EFFECTS / ADVERSE REACTIONS

Below is a sample of reports where side effects / adverse reactions may be related to Carboplatin. The information is not vetted and should not be considered as verified clinical evidence.

Possible Carboplatin side effects / adverse reactions in 60 year old male

Reported by a consumer/non-health professional from United States on 2011-10-02

Patient: 60 year old male weighing 82.0 kg (180.4 pounds)

Reactions: Diverticulitis

Adverse event resulted in: hospitalization

Suspect drug(s):
Cetuximab
    Dosage: 400mg/m2:19apr2011(loading dose) 250mg/m2:19apr to ong last dose:24may2011
    Indication: Head and Neck Cancer
    Start date: 2011-04-19
    End date: 2011-04-19

Carboplatin
    Dosage: 1df:5auc last dose:10may2011
    Indication: Head and Neck Cancer
    Start date: 2011-04-19

Pemetrexed Disodium
    Dosage: last dose:10may2011
    Indication: Head and Neck Cancer
    Start date: 2011-04-19

Other drugs received by patient: Levaquin; Lysine; Zofran; Potassium; Azelastine HCL; Clotrimazole; Vicodin; Magnesium; Vitamin B-12; Lactobacillus; Flagyl; Fish OIL; Diltiazem HCL; Levothyroxine; Methocarbamol; Nystatin; Flonase; Lorazepam; Dexamethasone; Nexium; Morphine; Compazine; Aprepitant; Liothyronine Sodium; Flomax; Coumadin



Possible Carboplatin side effects / adverse reactions in 55 year old female

Reported by a physician from Japan on 2011-10-03

Patient: 55 year old female weighing 43.3 kg (95.3 pounds)

Reactions: Septic Shock

Adverse event resulted in: death, hospitalization

Suspect drug(s):
Doxorubicin Hydrochloride
    Dosage: 30 mg/m2 x 1/4 week
    Start date: 2011-07-20
    End date: 2011-09-06

Etoposide
    Dosage: 100 mg/m2, x 1 / 4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-28
    End date: 2011-07-30

KW-0761
    Dosage: 1.0 mg/kg, x 1 / 2week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-14
    End date: 2011-08-17

Prednisolone
    Dosage: 40 mg/m2, x 1 / 4week
    Administration route: Oral
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-13
    End date: 2011-08-18

Vindesine Sulfate
    Dosage: 2.4 mg/m2, x 1 / 4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-28
    End date: 2011-07-28

Doxorubicin Hydrochloride
    Dosage: 40 mg/m2 x 1/4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-13
    End date: 2011-08-18

Methotrexate Sodium
    Dosage: 15 mg, 1 / 8week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-08-16

Cyclophosphamide
    Dosage: 350 mg/m2, x 1 /4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-13
    End date: 2011-08-18

Prednisolone
    Dosage: 40 mg/m2, x 1 / 4week
    Administration route: Oral
    Start date: 2011-07-28
    End date: 2011-07-30

Ranimustine
    Dosage: 60 mg/m2, x 1 / 4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-20
    End date: 2011-09-06

Prednisolone Sodium Succinate INJ
    Dosage: 10 mg, x 1 / 8week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-08-16

Cytarabine
    Dosage: 40 mg, x 1 / 8week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-08-16

Vincristine Sulfate
    Dosage: 1 mg/m2, x 1 / 4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-13
    End date: 2011-08-18

Prednisolone
    Dosage: 40 mg/m2, x 1 / 4week
    Administration route: Oral
    Start date: 2011-07-20
    End date: 2011-09-06

Carboplatin
    Dosage: 250 mg/m2, x 1 / 4week
    Indication: Adult T-Cell Lymphoma/leukaemia
    Start date: 2011-07-28
    End date: 2011-07-28

Other drugs received by patient: Solu-Medrol; Levothyroxine Sodium; Prepenon; Amizet; Potassium Phosphate Dibasic; Neoparen No.2; Funguard; Intrafat; NEO-Mercazole TAB; Sodium Bicarbonate; Pasil; Famotidine



Possible Carboplatin side effects / adverse reactions in 71 year old male

Reported by a health professional (non-physician/pharmacist) from Germany on 2011-10-03

Patient: 71 year old male weighing 50.0 kg (110.0 pounds)

Reactions: Pneumonia, Atrial Fibrillation, Circulatory Collapse

Adverse event resulted in: hospitalization

Suspect drug(s):
Carboplatin
    Dosage: recent dose:23may06; 04-23may-2006
    Indication: non-Small Cell Lung Cancer
    Start date: 2006-03-17

Paclitaxel
    Dosage: recent dose: 30-apr-2006.
    Indication: non-Small Cell Lung Cancer
    Start date: 2006-03-17

Vinorelbine
    Dosage: recent dose:23may06
    Indication: non-Small Cell Lung Cancer
    Start date: 2006-05-04



See index of all Carboplatin side effect reports >>

Drug label data at the top of this Page last updated: 2014-07-24

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