Carboplatin (CBP)
Carboplatin is also a broad-spectrum anti-tumor drug. Mainly through structural changes, carboplatin is more water-soluble, about 17 times that of cisplatin. Carboplatin is not significantly nephrotoxic compared to cisplatin, however, the level of renal function before treatment may be related to the degree of thrombocytopenia that occurs after treatment, so patients with low glomerular filtration rate (GFR) are more likely to develop thrombocytopenia. Therefore, it is clinically recommended to adjust the dose of carboplatin according to the patient's GFR level.
Carboplatin has more indications, mainly used for the treatment of ovarian cancer, lung cancer, other germline tumors, head and neck tumors, esophageal cancer, etc., the efficacy is slightly worse than cisplatin, mostly used for patients who are intolerant to cisplatin kidney function damage, vomiting, hearing impairment, etc.
The dosage of carboplatin is calculated mainly based on the patient's baseline creatinine clearance. This is a fixed formula for doctors. Clinically, creatinine clearance can also be calculated by serum creatinine (Cr) due to the complexity of creatinine clearance detection. It should be noted that the calculation method of creatinine clearance in men and women is different, and attention needs to be paid to distinguishing. In practice, dose adjustment is also required based on the patient's medical history, general condition, and treatment tolerance.
The adverse effects of carboplatin are mild compared to cisplatin, but the bone marrow suppression of carboplatin is stronger than that of cisplatin, especially thrombocytopenia, which is a dose-limiting toxicity. The incidence of gastrointestinal toxicity, nephrotoxicity, and neurotoxicity (ototoxicity) is low, so it can be used as a replacement for some patients with intolerance to cisplatin. However, carboplatin increases nephrotoxicity and ototoxicity when used in combination with aminoglycosides.
Nidaplatin (Nedaplatin, Aqupla)
Nidaplatin is original in Asia, has more applications in Asia, less use in Europe and the United States, and the relevant clinical data are not much. In terms of therapeutic efficacy and the wide range of indications, the data of nidaplatin are inferior to cisplatin. Among the adverse reactions, the gastrointestinal reactions and nephrotoxicity of nidaplatin are also lower than cisplatin, and most of them are currently used in the treatment of esophageal cancer. The bone marrow suppression response of nidaplatin is marked by a decrease in platelets, which exceeds that of cisplatin. When nidaplatin is combined with radiation therapy, the sensitization effect on radiotherapy exceeds that of cisplatin.
Nidaplatin is currently commonly used in the clinical treatment of esophageal cancer, non-small cell and small cell lung cancer, head and neck tumors, and ovarian cancer. Usage and dosage are comparable to cisplatin. Dose-limit toxicity of nidaplatin is mainly manifested in the bone marrow suppression of leukopenia and thrombocytopenia, especially the thrombocytopenic response. During the preparation process, care needs to be taken to avoid acidic solutions dissolved below pH below 5, nidaplatin has a certain irritation to blood vessels.
Oxaliplatin (platinum oxalate, Oxaliplatin, L-OHP, OXA)
Oxaliplatin is representative of the so-called third-generation platinum chemotherapy drugs. Oxaliplatin is mainly used in clinical treatment of colorectal cancer, gastric cancer, pancreatic cancer, bile duct cancer, liver cancer, etc., and is also used in non-small cell lung cancer, ovarian cancer, lymphoma, head and neck tumors. During its use, adverse reactions are fewer and lighter, and patients with hepatic insufficiency do not need to carry special doses, and there is no need for hydration during use. Clinically, oxaliplatin is often used in combination with 5-fluorouracil and various derivatives.
In the process of use, the prominent adverse reactions of oxaliplatin are its neurotoxic reactions, mainly manifested as peripheral neuritis, the incidence rate is about 80%, and some patients may sometimes have spasm and sensory impairment in the perioral, upper respiratory tract, upper gastrointestinal tract, and these adverse reactions are usually reversible. When the cumulative dose is too high, permanent paresthesias and dysfunction may occur. In gastrointestinal toxicity and bone marrow suppression, in addition to granulocytes and thrombocytopenia, special attention is paid to the occurrence of anemia. Due to structural reasons, oxaliplatin needs to be diluted with glucose solution when formulating, and cannot be dissolved or diluted with salt solution, oxaliplatin has irritation to blood vessels.
Loplatin (Le Platinum, Lobaplatin, LBP)
Loplatin is mainly used in the treatment of ovarian cancer in the clinic, in addition, it can also be used in breast cancer, small cell lung cancer and chronic myelogenous leukemia. Compared with cisplatin, the incidence of adverse reactions such as hair loss, nephrotoxicity, and ototoxicity was reduced, but the incidence of hematotoxicity was relatively high, especially the incidence of thrombocytopenia was higher. Loplatin is mainly metabolized by the kidneys, and the patient's creatinine clearance is the main factor affecting the patient's adverse reactions. For the observation of thrombocytopenia, in the treatment of ovarian cancer, the incidence can reach 75%. Thrombocytopenia is usually reversible, but during this period it can lead to some secondary side effects, such as bleeding due to thrombocytopenia, infection caused by leukopenia, etc., which may increase myelotoxicity if used in conjunction with other bone marrow inhibitors during treatment. However, on the whole, its gastrointestinal toxicity, neurotoxicity, liver and kidney toxicity are relatively low. Allergic reactions are rare. In addition, when lobplatin is formulated, it cannot be dissolved or diluted with a salt solution, and loplatin also has a certain stimulating effect on blood vessels.