What are the side effects of carboplatin?

From the Guidelines

Carboplatin can cause several side effects, including nausea, vomiting, bone marrow suppression, hair loss, kidney function impairment, peripheral neuropathy, electrolyte imbalances, and allergic reactions, with the risk of severe reactions increasing with repeated exposure 1.

Common Side Effects

• Nausea and vomiting, typically occurring within 24 hours of treatment, can be managed with anti-nausea medications.
• Bone marrow suppression, leading to decreased blood cell counts, particularly platelets, increases the risk of bleeding, infection, and fatigue, typically occurring 2-3 weeks after treatment.
• Hair loss, though less severe than with some other chemotherapy drugs, may occur.
• Kidney function can be affected, so patients receive IV fluids during treatment to protect the kidneys.

Less Common Side Effects

• Peripheral neuropathy, characterized by numbness or tingling in hands and feet, may develop, especially with higher doses or prolonged treatment.
• Electrolyte imbalances, particularly low magnesium, sodium, and potassium levels, can occur.
• Allergic reactions, ranging from mild rash to severe anaphylaxis, can occur, with the risk increasing with repeated exposure.
• Less common side effects include hearing loss, liver function abnormalities, and taste changes.

Management of Side Effects

• Many side effects can be managed with supportive care, such as anti-nausea medications, IV fluids, and monitoring of blood cell counts and kidney function.
• Patients should be counseled about the possibility of a drug reaction and educated about the signs and symptoms of an adverse reaction, and treated in a medical setting where appropriate medical equipment is available in case of an allergic reaction 1.

From the FDA Drug Label

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, USP, 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. 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. Peripheral neuropathies have been observed in 4% of the patients receiving carboplatin, USP (6% of pretreated ovarian cancer patients) with mild paresthesias occurring most frequently Development of abnormal renal function test results is uncommon, despite the fact that carboplatin, USP, unlike cisplatin, has usually been administered without high-volume fluid hydration and/or forced diuresis 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%; Hypersensitivity to carboplatin, USP has been reported in 2% of the patients. Injection site reactions, including redness, swelling, and pain, have been reported during postmarketing surveillance.

The side effects of carboplatin include:

• Hematologic effects:
  • Anemia (71% of patients) 2
  • Leukopenia (15% of patients) 2
  • Thrombocytopenia (25% of patients) 2
  • Neutropenia (16% of patients) 2
• Gastrointestinal effects:
  • Vomiting (65% of patients) 2
  • Nausea (10-15% of patients) 2
  • Diarrhea (6% of patients) 2
  • Constipation (6% of patients) 2
• Neurologic effects:
  • Peripheral neuropathies (4% of patients) 2
• Nephrotoxicity: Development of abnormal renal function test results is uncommon 2
• Hepatic toxicity: Abnormal liver function tests (5-24% of patients) 2
• Allergic reactions: Hypersensitivity to carboplatin (2% of patients) 2
• Injection site reactions: Redness, swelling, and pain 2
• Other effects:
  • Fever 2
  • Pain 2
  • Asthenia 2
  • Alopecia (3% of patients) 2
  • Cardiovascular events (less than 1% of patients) 2

From the Research

Side Effects of Carboplatin

The side effects of carboplatin can be severe and dose-limiting. Some of the common side effects include:

• Myelosuppression, which is the dose-limiting side effect of carboplatin 3, 4, 5
• Nausea and vomiting, although symptoms are usually delayed for several hours and are mild to moderate in severity 4, 5
• Anaphylaxis, cytopenias (including leukopenia and neutropenia, thrombocytopenia, and anaemia) 3
• Hepatotoxicity, ototoxicity, cardiotoxicity, diarrhea, mucositis, stomatitis, pain, alopecia, anorexia, cachexia, and asthenia 3
• Thrombocytopenia and leucopenia, which may be more severe in older patients or in those with renal impairment or those who have had previous chemotherapy 4, 5

Management of Side Effects

To manage the side effects of carboplatin, patients may be prescribed additional non-chemotherapy based drugs, such as:

• Antiemetics to prevent nausea and vomiting 3, 5
• Antibiotics and myeloid growth factors to prevent infection and promote blood cell production 3, 6, 7
• Mannitol, propafenone, saline hyperhydration, magnesium supplements, monoclonal antibody cytokine blockers, and antioxidants to prevent other side effects 3

Monitoring and Dose Adjustment

Patients receiving carboplatin require extensive monitoring of their biochemistries, kidney and liver function, and depending on the drug, hearing tests 3. The dose of carboplatin may need to be adjusted based on the patient's renal function and the severity of side effects 5.