LAUSR

Abstract Following the breakthrough discovery of cisplatin, carboplatin was developed as a less toxic analogue, acting by the same mechanism. Early clinical studies showed that it largely lacked the nephron-, oto-, and neurotoxicity of cisplatin while still having substantial anti-tumour activity. Leukopenia was similar to that seen with cisplatin while thrombocytopaenia was more marked. Carboplatin was not immediately adopted by a pharma company or by the oncology community at large, meaning that most of the early development was done in an academic environment making use of regulatory exemptions. The demonstration of activity in ovarian cancer similar to that of cisplatin but with greatly reduced non-haematological toxicities led to its adoption by pharma for development and licensing. Sporadic thrombocytopaenia hampered the clinical uptake, but this was resolved by the use of a dosing formula based on renal function. The combination of carboplatin with a taxane turned out to be particularly useful and a randomised trial in this context has established carboplatin as the standard of care for ovarian cancer. Carboplatin is not used in the first-line treatment of adult germ cell tumours because randomised trials showed it to be inferior. It is possible that this result was due to dosing issues. Carboplatin is now used worldwide in a wide variety of cancers and is particularly useful in paediatric tumours where the long-term toxicities of cisplatin are problematic.