Carboplatin and Mesothelioma

Expert Fact Checked

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James Stevenson, M.D. Thoracic Medical Oncologist

Carboplatin (Paraplatin®) is a chemotherapy drug that contains platinum. It can trigger cell death in fast-growing cells, like those of mesothelioma cancer. Carboplatin is a less toxic alternative to other chemotherapies. It does not have regulatory approval for mesothelioma, but it has shown promise in studies when used with pemetrexed.

01. What Is Carboplatin?

What Is Carboplatin?

Carboplatin is a chemotherapy drug used to treat many forms of cancer, including some caused by asbestos exposure. It contains platinum, which helps it bond with DNA. These bonds interrupt normal cell operations. The interruption inhibits cell growth and triggers the natural process of cell death. It affects quickly dividing cells, like cancer cells, more than slower dividing cells. This means carboplatin affects cancer cells more than normal cells.

Carboplatin is a standard treatment for ovarian cancer in many countries. It is also part of some chemotherapy regimens approved by the U.S. Food and Drug Administration (FDA). Carboplatin is part of an FDA-approved combination chemotherapy for non-squamous non-small cell lung cancer (NSCLC).

Carboplatin does not have FDA approval to treat mesothelioma. But researchers commonly use it in studies when patients cannot tolerate cisplatin. Cisplatin is another platinum chemotherapy drug. Research suggests carboplatin may be well suited for older mesothelioma patients or patients who struggle with daily activities.

Carboplatin Quick Facts

  • Generic name: Carboplatin
  • Brand name: Paraplatin®
  • Administration: Intravenous
  • Often combined with: Carboplatin is often combined with pemetrexed. Both work to disrupt cancer cell growth.
  • Types of mesothelioma treated: Biphasic mesothelioma, epithelial mesothelioma, peritoneal mesothelioma, pleural mesothelioma, sarcomatoid mesothelioma
  • Manufacturer: Accord Healthcare Inc., AuroMedics Pharma LLC, Cipla USA Inc., Fresenius Kabi USA, LLC, Gland Pharma Limited, Hospira Inc., Meitheal Pharmaceuticals Inc., Sanja Pharmaceuticals Company, Sun Pharmaceutical Industries Inc., Teva Parenteral Medicines Inc.
  • FDA approval: Carboplatin is approved for first-line treatment of advanced ovarian cancer in combination with other chemotherapy drugs (such as cyclophosphamide). Carboplatin is approved for palliative treatment of ovarian cancer in patients who have experienced recurrence after prior chemotherapy. Carboplatin is approved for use with Avastin® as part of a first-line therapy for non-squamous NSCLC.
02. Carboplatin and Mesothelioma

How Does Carboplatin Treat Mesothelioma?

Carboplatin is a chemotherapy drug. Like cisplatin, carboplatin contains platinum. When used to treat cancer, carboplatin binds with cell DNA. This binding interferes with normal cell operation, leading to a process called apoptosis. Apoptosis causes the cell to die. Carboplatin affects cells that divide rapidly, such as mesothelioma cells, more than normal cells.

Carboplatin does show up in mesothelioma cancer treatment studies combined with other drugs, like pemetrexed (Alimta®). Many experts believe combining mesothelioma drugs is the most effective way to treat some diseases.

Carboplatin is similar to cisplatin, but doctors consider it to be less toxic. Doctors may prescribe carboplatin to older patients or those who have poor performance status. Poor performance status means a person struggles with normal activities such as work or taking care of themselves.

Carboplatin does not have FDA approval to treat mesothelioma, but it does have a recommendation from the American Society of Clinical Oncology (ASCO). ASCO guidelines recommend offering carboplatin for inoperable mesothelioma patients who may not tolerate cisplatin. According to the society, “carboplatin is generally better tolerated” than cisplatin. Thus, carboplatin is a standard treatment option for mesothelioma, despite lacking a corresponding FDA approval.

Carboplatin and Pemetrexed for Pleural Mesothelioma

Carboplatin and pemetrexed chemotherapy is a standard treatment option for mesothelioma patients who cannot tolerate cisplatin. Doctors have also used carboplatin in combination with pemetrexed in clinical trials. Patients eligible for treatment with carboplatin may have unresectable or resectable pleural mesothelioma.

Resection is the process of cutting out tissue or parts of an organ. If something is unresectable it is not capable of being surgically removed. Doctors may also refer to unresectable tumors as inoperable.

Cisplatin is one of the most frequently used chemotherapy drugs in mesothelioma care. Carboplatin may be used as a replacement for cisplatin in some malignant mesothelioma cases. Both drugs contain platinum. Experts often recommend carboplatin in patients who may not tolerate cisplatin.

Carboplatin and pemetrexed work in combination to kill cancer cells. Effectiveness varies depending on multiple factors, including:

  • Administration route (how the drugs are given)
  • Mesothelioma cell type
  • Patient characteristics
  • Tumor location (pleural or peritoneal)

Reported survival for mesothelioma patients treated with carboplatin and pemetrexed ranges from about one to two years. One study looked at pleural mesothelioma patients who were ineligible for surgery. After treatment with carboplatin and pemetrexed, these patients had a median survival of 12.7 months.

Another study combined three treatments for pleural mesothelioma patients:

  1. Pemetrexed and cisplatin or carboplatin
  2. Pleurectomy/decortication
  3. Radiation therapy

These study patients had a median survival of 23.7 months.

Carboplatin in HIPEC Procedures for Peritoneal Mesothelioma

Doctors commonly treat peritoneal mesothelioma with surgery and heated chemotherapy. This heated chemotherapy is called hyperthermic intraperitoneal chemotherapy (HIPEC). Some HIPEC procedures use carboplatin.

HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a form of heated chemotherapy that doctors administer in the abdomen. HIPEC may cause fewer side effects than traditional chemotherapy because it is concentrated in the abdomen. Traditional systemic chemotherapy is administered through a vein and circulates throughout the bloodstream.

Before administering HIPEC for peritoneal mesothelioma, doctors often begin by performing cytoreductive surgery (CRS). CRS is a surgery that removes as much tumor tissue as possible. After CRS, the patient’s abdomen receives a heated carboplatin wash. It allows the chemotherapy drugs to have direct contact with the cancer cells that may remain after surgery.

In one study of surgery and HIPEC using carboplatin, results included:

  • One-year survival of 89.7%
  • Five-year survival of 62.5%

HIPEC and carboplatin may not be available to all patients. Patients should speak to their oncologist about HIPEC and their eligibility.

03. What to Expect

What to Expect During Treatment

Carboplatin and pemetrexed are recommended treatments for mesothelioma, but they do not have a related FDA approval. As such, treatment protocols may vary by cancer center and the prescribing doctor. Patients receiving this combination may have a treatment regimen similar to that in published literature.

In one study, patients received some supplements and medication before chemotherapy infusion. Patients received:

  • Oral folic acid every day for one to two weeks before the first cycle
  • An injection of vitamin B12 one to two weeks before treatment and then every nine weeks throughout treatment
  • An oral corticosteroid twice daily for three days starting the day before treatment

Patients received these supplements to help tolerate the treatment and reduce side effects.

Patients then received treatment on a 21-day cycle. Infusions occurred on the first day of the cycle. The next three weeks were a recovery period.

On the infusion day, patients received both pemetrexed and carboplatin. The infusion process took roughly an hour. The process was:

  • A dose of pemetrexed administered over a period of 10 minutes
  • 30 minutes of rest
  • A dose of carboplatin administered over a period of 30 minutes

After the infusion, study participants rested for three weeks. They returned for more cycles as needed. Patients received a varying number of cycles. The median number was six cycles. The highest number of cycles patients had was 20.

Any mesothelioma patient receiving carboplatin chemotherapy can discuss the treatment plan with their oncologist. The physician can help the patient determine the appropriate number of chemotherapy cycles for their unique situation.

Preparing for Your Appointment

Patients have a few things they can do before their appointment to get ready. Having everything in order before the first appointment may help relieve some stress. Specific steps to get ready for treatment include:

  • Dress comfortably: Patients may feel better wearing warm, loose-fitting clothes. Treatment areas can be cold, so dressing warmly can help. Loose-fitting clothes help healthcare professionals easily access parts of the body where they may need to make injections.
  • Organize your information: Healthcare professionals may ask a lot of questions before a patient’s first treatment. Having the answers to key questions ready may help patients feel more in control. Be sure to include basic information, such as phone number, address and insurance information.
  • Pack a bag: Patients may want to bring some entertainment and snacks. Some patients may also want to bring a blanket, pillow or some other comfort from home. Check with the treatment center for specific guidelines.
  • Plan transportation: While some patients can drive themselves to their appointment, they may prefer having someone drive them. Patients react to drugs differently, and they may find themselves too tired to drive.

Before treatment, patients will speak with their doctors about the treatment. They may want to talk about the procedure, side effects and any other concerns.

Managing Treatment and Follow-Up Care

Patients may have several chemotherapy cycles. How many cycles depends greatly on the individual and the treatment plan. In one study, the median number of cycles was six.

If a treatment plan includes carboplatin, there are several recommendations for patients to help ease potential side effects. These recommendations include:

  • Avoiding crowds where the risk of infection is higher
  • Eating a healthy diet
  • Getting plenty of rest
  • Staying hydrated
  • Washing hands frequently

Doctors will monitor patients for any needed follow-up care between treatment cycles. Patients may have blood tests and other tests to determine how the drug is performing. Doctors will pay particular attention to liver and kidney function.

These follow-up visits are important. They allow doctors to check the patient’s health, and it also gives the patient the chance to ask questions. Patients should keep track of how they are feeling during treatment and discuss it with their doctor.

04. Benefits of Carboplatin

Carboplatin Benefits

Doctors are still studying carboplatin to improve its effectiveness in treating pleural mesothelioma. Carboplatin does not have FDA approval to treat mesothelioma, but doctors can still prescribe it.

Carboplatin is similar to FDA-approved cisplatin. According to one publication, carboplatin was shown to be less toxic than cisplatin. In particular, carboplatin may be less toxic to the kidneys and gastrointestinal tract than cisplatin.

For elderly patients, a carboplatin and pemetrexed combination may be a good option because of the lower toxicity. It may also be a good option for patients with decreased ability to care for themselves. And, because it tends to be better tolerated, some researchers suggest it should be used as a palliative care option.

Doctors have also tested carboplatin in HIPEC for peritoneal mesothelioma. This treatment is a heated wash of the abdominal cavity following surgery. In some studies, HIPEC has shown to be an effective treatment option to extend patient survival.

05. Side Effects of Carboplatin

Carboplatin Side Effects

Patients receiving carboplatin to treat mesothelioma may experience side effects. Side effects vary from person to person and depend on a variety of factors. Side effects also vary depending on how carboplatin is administered. For example, patients receiving HIPEC may be less likely to experience hair loss because the drug does not circulate throughout the whole body.

Carboplatin side effects have been extensively studied in ovarian cancer patients. These patients reported several common side effects, including nausea, vomiting, hair loss and feeling tired. Other commonly reported side effects included an increased risk of infection and anemia.

A patient can speak to their mesothelioma doctor about any concerns. The doctor will be able to explain any potential side effects and their risks. Their doctor and the healthcare team may also suggest ways to ease the side effects.

Potential Side Effects of Carboplatin

  • Altered levels of some blood proteins (urea)
  • Cognitive changes
  • Delirium
  • Hair loss
  • Hearing damage
  • Heart problems
  • Infection
  • Liver damage
  • Low platelet levels
  • Low red blood cell levels
  • Low white blood cell levels
  • Nausea
  • Nerve damage
  • Pain
  • Seizures
  • Tremors
  • Vomiting
  • Weakness or fatigue

Managing Side Effects

Patients should speak to their doctors about any side effects or concerns. The doctor can explain potential side effects and their risks. The doctor and the healthcare team may also suggest ways to ease the side effects.

Mesothelioma patients may manage side effects during treatment by following their doctor’s advice. This advice may help maintain quality of life during treatment. Doctors may prescribe medications or nutritional changes.

For example, patients may be given folic acid and vitamin B12 before beginning treatment. These supplements may help the patient avoid severe skin reactions. Also, a course of corticosteroid may help with skin rashes caused by treatment.

Patients may want to speak with their doctor if they experience any side effects. They may also want to discuss taking any supplements. Some nutritional supplements can interact with chemotherapy drugs, making them less effective.

06. Carboplatin Eligibility

Who Is Eligible for Carboplatin?

Not every patient diagnosed with mesothelioma will be eligible for carboplatin as part of a treatment plan. Elderly people and those who have trouble caring for themselves may be eligible for a carboplatin and pemetrexed combination treatment.

Some patients may not be eligible to take carboplatin. Some factors limiting eligibility include:

  • A history of allergic reaction to cisplatin or other platinum-containing compounds
  • Severe bone marrow suppression
  • Significant bleeding

Patients may want to speak to their doctor to find out if carboplatin is right for them. The doctor can explain the potential benefits and risks of using carboplatin as part of a treatment plan. The doctor may also recommend other treatment options.

07. Carboplatin Studies

Clinical Trials and Studies on Carboplatin for Pleural Mesothelioma

Carboplatin has appeared in several studies to see how effective it is in treating malignant mesothelioma. In general, studies have shown carboplatin has fewer side effects than cisplatin.

One study included 102 patients with inoperable pleural mesothelioma. Study participants were given a combination of carboplatin and pemetrexed. Researchers found survival similar to that of patients who received cisplatin and pemetrexed.

Another study of carboplatin and pemetrexed included 62 patients. It examined the combination as a first-line treatment for inoperable malignant mesothelioma. At last follow-up, 55% of patients showed no spreading or tumor growth. Also, it showed that cell type played a significant role in survival. Epithelioid mesothelioma patients survived about 16 months. Yet, sarcomatoid mesothelioma patients survived about 11 months.

A third study involved using Tumor Treating Fields (TTFields) with a chemotherapy combination of pemetrexed and cisplatin or carboplatin. TTFields therapy is a newer treatment that uses low-intensity electrical currents to disrupt cell division, slowing or stopping cancer growth. Researchers found study participants had a median survival of 18.2 months.

Improving Carboplatin’s Effectiveness

Researchers are still investigating new ways of using carboplatin to treat mesothelioma. These studies may find treatment options that can help mesothelioma patients.

One such study is taking place in China. This phase II trial will look at how pemetrexed and cisplatin or carboplatin work when combined with immunotherapy. While American mesothelioma patients cannot take part, they may benefit from the findings.