CARBOPLATIN AND UROTHELIAL TUMORS - AN OV ERVIEW

Polychemotherapy appears to increase survival moderately but at a cost of severe toxicity, mainly due to cisplatin. New platinum salts (chie fly carboplatin) have therefore been developed. This review on the use of carboplatin in advanced-stage urothelial tumours was undertaken to find the actual place of carboplatin in the treatment of these tumour s, and to describe its best use in polychemotherapy. In 322 patients, carboplatin alone gave 12.9% objective responses (OR), 2.5% complete r esponses (CR) and 10.4% partial response (PR). Many polychemotherapy p rotocols were used, most frequently carboplatin/methotrexate/vinblasti n. The results were OR: 63%, CR: 19%, PR: 44% among 146 patients; Thes e results confirm the relative efficiency of carboplatin on urothelial tumours, particularly when used in combination. Because of the lack o f prospective studies and the wide disparity in the doses and in the d ose adjustement, no comparison can be made with cisplatin. Carboplatin has virtually no renal toxicity at the usual doses, and does not requ ire hyperhydratation. The pharmacokinetic behaviour of the two platinu m salts is highly different, as carboplatin does nor undergo tubular m etabolism The efficiency and tolerance of carboplatin used to be optim ised by adapting the dose to the glomerular filtration rate, as was sh own for germ cell rumours. In conclusion, these considerations fully w arrant further clinical trials of carboplatin.