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Platinum-Based Chemotherapy Pregnancy: Contraindicated — cytotoxic

Carboplatin

Brand names: Paraplatin

Adult dose

Dose: AUC 4-6 IV every 3-4 weeks (Calvert formula: dose = AUC x (eGFR + 25))
Route: Intravenous infusion (over 15-60 minutes)
Frequency: Every 3-4 weeks
Max: Calculated by Calvert formula — AUC 5-6 is typical target
Dose calculated using Calvert formula based on target AUC and eGFR. Less emetogenic than cisplatin — standard antiemetic premedication required but less intensive

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Dose adjusted by Calvert formula based on eGFR — inherently renal-function dependent; reduce AUC target in significant renal impairment

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Carboplatin is used in cisplatin-ineligible patients (eGFR under 50, neuropathy, hearing impairment) — GCarbo regimen (gemcitabine + carboplatin) for advanced urothelial carcinoma
  • Calvert formula must be used for dose calculation — flat-dose prescribing is inappropriate and dangerous; eGFR measured by creatinine clearance or nuclear medicine GFR if accuracy needed
  • Thrombocytopenia nadir: day 21 — platelet transfusion threshold typically below 10 x 10^9/L; monitor closely
  • Platinum hypersensitivity reactions increase with cumulative number of cycles — onset typically after 6 or more cycles; treat with desensitisation protocol or switch agent
  • EAU guidelines: carboplatin-based combinations have inferior outcomes to cisplatin in fit patients — only use if cisplatin is genuinely contraindicated

Contraindications

  • Severe myelosuppression
  • Severe renal impairment (eGFR under 20 — dose becomes negligible)
  • Severe haemorrhagic tumours
  • Hypersensitivity to platinum compounds

Side effects

  • Thrombocytopenia (dose-limiting — more than cisplatin)
  • Neutropenia
  • Anaemia
  • Nausea and vomiting (less severe than cisplatin)
  • Peripheral neuropathy (less than cisplatin)
  • Nephrotoxicity (less than cisplatin)
  • Hypersensitivity reactions (especially after multiple cycles)

Interactions

  • Nephrotoxic agents (additive risk)
  • Aminoglycosides (additive toxicity)

Monitoring

  • FBC (especially platelets — day 21 nadir)
  • eGFR (Calvert formula recalculation each cycle)
  • Signs of hypersensitivity
  • Peripheral neuropathy

Reference: BNFc; BNF 90; EAU Bladder Cancer Guidelines 2024; Calvert et al. (1989) formula; NICE NG2. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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