From the Guidelines
In a chemoradiation therapy (CRT) setting, carboplatin and paclitaxel are typically administered concurrently with radiation therapy, with carboplatin dosed at AUC 2 and paclitaxel at 45-50 mg/m² given intravenously once weekly throughout the radiation treatment period, which typically lasts 5-6 weeks. This regimen is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The administration of carboplatin and paclitaxel in this manner is supported by evidence from studies such as RTOG 0617, which demonstrated that concurrent chemoradiation with carboplatin and paclitaxel is a effective treatment for stage III non-small-cell lung cancer 1.
Some key points to consider when administering carboplatin and paclitaxel in a CRT setting include:
- Pre-medication with dexamethasone, diphenhydramine, and an H2 blocker to prevent hypersensitivity reactions to paclitaxel
- Weekly blood counts to assess for myelosuppression and potential dose adjustments based on toxicity
- The concurrent approach is used because these agents act as radiosensitizers, enhancing the effectiveness of radiation by interfering with cancer cells' ability to repair radiation-induced DNA damage
- Carboplatin forms platinum-DNA adducts that inhibit DNA replication, while paclitaxel stabilizes microtubules, preventing cell division and increasing cellular sensitivity to radiation
It's worth noting that other studies, such as the NCCN clinical practice guidelines, also support the use of carboplatin and paclitaxel in a CRT setting, although the specific dosing and administration schedule may vary depending on the individual patient and cancer type 1. However, the most recent and highest quality study available, RTOG 0617, provides the strongest evidence for the use of carboplatin and paclitaxel in a CRT setting 1.
From the Research
Administration of Carboplatin and Paclitaxel in CRT Setting
- The administration of carboplatin and paclitaxel in a Chemoradiation Therapy (CRT) setting can vary depending on the specific cancer type and treatment protocol.
- In the treatment of advanced ovarian cancer, carboplatin and paclitaxel can be administered every 3 weeks, with paclitaxel given as a 3-hour intravenous infusion and carboplatin given as an intravenous infusion with an area under the curve (AUC) of 6 mg/mL per min 2.
- For locally advanced squamous cell carcinomas of the head and neck, carboplatin and paclitaxel can be given weekly during radiation therapy, with paclitaxel administered at a dose of 45 mg/m2/week and carboplatin at a dose of 100 mg/m2/week 3.
- In the treatment of advanced oesophageal carcinoma, carboplatin and paclitaxel can be administered concurrently with radiation therapy, with paclitaxel given at a dose of 50 mg/m2 and carboplatin at an AUC of 2, on days 1,8,15,22, and 29 4.
- A study comparing paclitaxel and carboplatin to cisplatin and 5-fluorouracil in concurrent chemoradiotherapy for esophageal cancer found that the paclitaxel and carboplatin regimen was associated with better survival outcomes and fewer severe adverse events 5.
- In locally advanced non-small-cell lung cancer, induction chemotherapy with paclitaxel and carboplatin can be followed by concurrent chemoradiotherapy with the same agents, with paclitaxel administered at a dose of 175-225 mg/m2 and carboplatin at a targeted AUC of 7.5 6.
Dosage and Administration
- The dosage and administration of carboplatin and paclitaxel can vary depending on the specific treatment protocol and cancer type.
- Common dosages include:
- Paclitaxel: 50-225 mg/m2
- Carboplatin: AUC of 2-7.5 mg/mL per min
- Administration schedules can include:
- Weekly administration during radiation therapy
- Every 3 weeks for induction chemotherapy
- Concurrently with radiation therapy
Toxicity and Efficacy
- The toxicity and efficacy of carboplatin and paclitaxel in CRT setting can vary depending on the specific treatment protocol and cancer type.
- Common toxicities include:
- Neutropenia
- Thrombocytopenia
- Fatigue
- Anaemia
- Radiation dermatitis
- Pneumonitis
- Oesophagitis
- Efficacy can be measured by:
- Overall survival
- Progression-free survival
- Response rate
- Disease-free survival