Carboplatin in pediatric malignancies

Carboplatin is an analogue of cisplatin, an agent that has found application in the cancers that afflict more than one half of children with malignancy. Exploration of the potential of cisplatin has been impeded by its severe and persistent ototoxicity and nephrotoxicity and its prolonged emetogenicity. At conventional doses, carboplatin appears to have a similar spectrum of activity. Its toxicity profile is limited largely to myelosuppression, which may be predicted with some precision from drug dose and glomerular filtration rate, and can be ameliorated with cytokine or bone marrow rescue. Cisplatin nephrotoxicity and especially ototoxicity have been less amenable to amelioration. Unlike cisplatin, carboplatin has demonstrated activity in adult acute myeloblastic leukemia. Exploration of carboplatin proceeds in the setting of bone marrow or cytokine rescue, in combination with nephrotoxic drugs like ifosfamide, in children with brain tumors who are especially susceptible to ototoxicity and in children with acute leukemia.