카보플라틴

항종양제 - 백금계 알킬화제

카보플라틴은 수의 종양학에서 널리 사용되는 2세대 백금계 항종양제입니다. 주로 다양한 암종 및 육종의 치료에 사용되며, 특히 절단 수술 후 **반려견 골육종**의 보조 요법으로 가장 잘 알려져 있습니다. **임상적 특징 및 장점:** * **고양이에서의 안전성:** 고양이에게 치명적인 폐부종을 유발하는 1세대 약물인 시스플라틴과 달리, 카보플라틴은 비교적 안전하여 고양이 환자에게도 일상적으로 사용됩니다. * **독성 감소:** 카보플라틴은 일반적으로 '더 순한' 백금계 약물로 간주됩니다. 시스플라틴에 비해 신독성 및 구토 유발 가능성이 현저히 낮아 치료 전후의 공격적인 정맥 수액 이뇨가 필요하지 않습니다. * **다양한 활용:** 전신 정맥 투여 외에도 체강 내(흉수), 동맥 내 및 병변 내(말 사코이드, 고양이 비강 평면 암종) 적용에서도 가능성을 보여주었습니다.

작용 기전: Carboplatin acts as a **bifunctional alkylating agent**. * **Cellular Entry & Activation:** Once inside the cell, the drug undergoes aquation (water molecules replace the cyclobutanedicarboxylate leaving group), forming highly reactive, positively charged platinum complexes. * **DNA Crosslinking:** These active complexes bind covalently to nucleophilic sites on DNA (primarily the N7 position of guanine and adenine). * **Inhibition:** This binding creates **intra-strand and inter-strand crosslinks** in the DNA double helix, physically obstructing DNA polymerases and RNA polymerases. * **Apoptosis:** The resulting DNA damage inhibits DNA replication, RNA transcription, and protein synthesis, ultimately triggering apoptosis (programmed cell death). > **Note:** Carboplatin is **cell-cycle nonspecific**, meaning it can damage cells during any phase of the cell cycle, though cells are most vulnerable during the G1 and S phases.

동물 종별 용량

Dogs

Antineoplastic · 300-350 mg/m2 · IV · every 3 weeks · Dosage may need adjustment in patients with reduced renal function.
Neoplastic diseases (All uses) · 300 mg/m2 · IV · q3-4wk · As determined by oncology protocol · Injected into the side port of a freely running i.v. infusion of 0.9% NaCl over a 10-15 min period.
Neoplastic diseases (Intrapleural/intraperitoneal) · 225-300 mg/m2 · Intrapleural/Intraperitoneal · As directed by specialist · As determined by oncology protocol · Diluted in 0.9% NaCl or 5% dextrose water over a 5-10 min period. Consult a veterinary oncology specialist before administering via this route.

Birds

Adenocarcinoma · Intralesional use may be considered · Intralesional

Cats

Antineoplastic · 180-260 mg/m2 · IV · every 3 weeks · Has also been administered intratumorally for nasal planum carcinomas.
Neoplastic diseases (All uses) · 200 mg/m2 · IV · q3-4wk · As determined by oncology protocol · Injected into the side port of a freely running i.v. infusion of 0.9% NaCl over a 10-15 min period. Monitor for delayed/unpredictable side effects.
Neoplastic diseases (Intrapleural/intraperitoneal) · 200-240 mg/m2 · Intrapleural/Intraperitoneal · As directed by specialist · As determined by oncology protocol · Diluted in 0.9% NaCl or 5% dextrose water over a 5-10 min period. Consult a veterinary oncology specialist before administering via this route.

Horses

투여 경로

IVIntratumoralIntracavitaryIntra-arterialIntralesional

금기

History of hypersensitivity to carboplatin or other platinum agents
Severe bone marrow depression
Pregnancy (fetotoxic and embryotoxic - Category D)

이상반응

Bone marrow suppression (neutropenia, thrombocytopenia)
Anorexia
Vomiting (typically 2-4 days post-dose)
Hepatotoxicity (elevated bilirubin and liver enzymes)
Nephrotoxicity (less frequent than cisplatin)
Neuropathies (rare)
Ototoxicity (rare)
Anaphylactoid reactions (rare)
Hyperuricemia

약물 상호작용

Aminoglycosides · Potential for increased risk of nephrotoxicity or ototoxicity. · major
Cisplatin · Patients previously treated with cisplatin have an increased risk of developing neurotoxicity or ototoxicity after receiving carboplatin.
Myelosuppressive drugs · The leukopenic or thrombocytopenic effects secondary to carboplatin may be enhanced.
Radiation therapy · Potential for increased hematologic toxicity.
Vaccines · Live or killed virus vaccines administered after therapy may have reduced efficacy. Carboplatin may also potentiate live virus vaccine replication and increase adverse effects.
Nephrotoxic agents (e.g., NSAIDs, Amphotericin B) · Increased risk of cumulative nephrotoxicity. · major
Vaccines (live) · May adversely affect the safety and efficacy of vaccinations due to immunosuppression. · major
Radiotherapy · Potential to act as a radiosensitizer for patients receiving concomitant radiotherapy. · moderate

모니터링

CBC (Complete Blood Count) to monitor nadir
Serum electrolytes
Uric acid
Baseline renal and hepatic function tests

과용량

An overdose of carboplatin is expected to cause severe, aggravated effects associated with the drug's primary toxicities: **bone marrow suppression, nephrotoxicity, and hepatotoxicity**. * **Monitoring:** Closely monitor for neurotoxicity, ototoxicity, hepatotoxicity, and nephrotoxicity. * **Treatment:** Therapy is primarily supportive as no specific antidote is available. Plasmapheresis or hemodialysis could potentially be of benefit in rapidly removing the drug from systemic circulation.

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