OBGYN Chemo: Carboplatin

I am an OBGYN resident. This video is intended for other medical residents and medical students that are interested in OBGYN and GYNONC.

Pharmacology:
a. Mechanism of Action: Carboplatin forms intrastrand and interstrand cross-links in DNA, inhibiting DNA replication and transcription, ultimately leading to cancer cell death.
b. Comparison with Cisplatin: Unlike cisplatin, carboplatin has reduced nephrotoxicity and neurotoxicity, making it a preferred choice for some gynecological cancers.

Indications:
a. Gynecological Cancers: Carboplatin is indicated for the treatment of advanced ovarian cancer, including epithelial ovarian carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma.
b. Combination Therapy: It is also used in combination with other chemotherapy agents for advanced endometrial and cervical cancers.

Dosing and Administration:
a. Calvert Formula: Carboplatin dosage is calculated based on the patient's body surface area (BSA) using the Calvert formula: Dose (mg) = Target AUC × (GFR + 25).
b. IV Administration: Carboplatin is administered intravenously over 15-60 minutes, and the infusion rate should not exceed 4.5 mg/minute.

Side Effects:
a. Hematological Side Effects: Common myelosuppressive effects include neutropenia, thrombocytopenia, and anemia. Regular monitoring of blood counts is necessary during treatment, and appropriate growth factor support may be required.
b. Non-Hematological Side Effects: Nausea, vomiting, and fatigue are common, and they can be managed with antiemetics and supportive care. Peripheral neuropathy, though less severe than with cisplatin, may still occur.
c. Renal and Ototoxicity: Carboplatin is less nephrotoxic and ototoxic compared to cisplatin, but patients should be monitored for any signs of renal impairment or hearing changes.

Monitoring and Management:
a. Blood Tests: Regular monitoring of complete blood counts (CBC), renal function tests, and liver function tests is crucial to assess treatment response and identify potential adverse effects.
b. Symptom Management: Supportive care measures should be implemented to manage side effects, such as nausea, vomiting, and neuropathy.

Precautions and Contraindications:
a. Contraindications: Carboplatin is contraindicated in patients with severe bone marrow suppression, severe bleeding, and known hypersensitivity to platinum-based compounds.
b. Pregnancy Considerations: Carboplatin may cause harm to the developing fetus, and careful consideration should be given to the risks and benefits when treating pregnant patients.

Collaborative Care:
a. Multidisciplinary Approach: OBGYN residents should work closely with oncology specialists to develop individualized treatment plans for gynecological cancer patients undergoing carboplatin therapy.
b. Communication with Patients: Effective communication with patients is essential to educate them about carboplatin treatment, its potential side effects, and the importance of adherence to the treatment plan.