[Carboplatin and urothelial tumors: review of the literature]

Abstract

Polychemotherapy appears to increase survival moderately but at a cost of severe toxicity, mainly due to cisplatin. New platinum salts (chiefly 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 tumours, and to describe its best use in polychemotherapy. In 322 patients, carboplatin alone gave 12.9% objective responses (OR), 2.5% complete responses (CR) and 10.4% partial response (PR). Many polychemotherapy protocols were used, most frequently carboplatin/methotrexate/vinblastin. The results were OR: 63%, CR: 19%, PR: 44% among 146 patients. These results confirm the relative efficiency of carboplatin on urothelial tumours, particularly when used in combination. Because of the lack of prospective studies and the wide disparity in the doses and in the dose adjustment, no comparison can be made with cisplatin. Carboplatin has virtually no renal toxicity at the usual doses, and does not require hyperhydratation. The pharmacokinetic behaviour of the two platinum salts is highly different, as carboplatin does not undergo tubular metabolism. The efficiency and tolerance of carboplatin used to be optimised by adapting the dose to the glomerular filtration rate, as was shown for germ cell tumours. In conclusion, these considerations fully warrant further clinical trials of carboplatin.