Regimen: Paclitaxel + Carboplatin +/-Etoposide
Hainsworth JD, Greco FA. J Clin Oncol 1997;15:2385–2393
Premedication against hypersensitivity reactions to paclitaxel:
Dexamethasone 20 mg per dose; administer orally for 2 doses at 12 hours and 4 hours before starting paclitaxel
Diphenhydramine 50 mg; administer by intravenous injection, 30–60 minutes before starting paclitaxel
Cimetidine 300 mg (or equivalent histamine H2 antagonist); administer intravenously in 25–100 mL 0.9% sodium chloride injection (0.9% NS) or 5% dextrose injection (D5W) over 15–30 minutes, before starting paclitaxel
Dexamethasone 20 mg; administer intravenously over 10–15 minutes, 30 minutes before starting paclitaxel
Paclitaxel 200 mg/m2; administer intravenously diluted in 0.9% NS or D5W to a concentration within the range 0.3 to 1.2 mg/mL, over 1 hour, before starting carboplatin on day 1, every 21 days (total dosage/cycle = 200 mg/m2)
Carboplatin [calculated dose] AUC = 6 mg/mL · min; administer intravenously diluted in 0.9% NS or D5W to a concentration >0.5 mg/mL over 20–30 minutes on day 1, every 21 days (total dosage/cycle calculated to produce an AUC = 6 mg/mL · min)
Etoposide 50 mg per dose; administer orally for 5 doses on days 1, 3, 5, 7, and 9, alternating with:
Etoposide 100 mg per dose; administer orally for 5 doses on days 2, 4, 6, 8, and 10 (total dose/cycle = 750 mg)
Supportive Care
Antiemetic prophylaxis
Emetogenic potential on day 1 is HIGH. Potential for delayed symptoms
Emetogenic potential on days 2 to 10 is LOW
See Chapter 39 for antiemetic recommendations
Hematopoietic growth factor (CSF) prophylaxis
Primary prophylaxis is NOT indicated
See Chapter 43 for more information
Antimicrobial prophylaxis
Risk of fever and neutropenia is LOW
Antimicrobial primary prophylaxis to be considered:
See Chapter 47 for more information
Carboplatin dose is based on a formula described by Calvert et al. to achieve a target area under the plasma concentration versus time curve (AUC)

In practice, creatinine clearance (Clcr) is used in place of glomerular filtration rate (GFR). Clcr can be estimated from the equation of Cockcroft and Gault, thus:


Note: On October 8, 2010, the U.S. FDA identified a potential safety issue with carboplatin dosing. By the end of 2010, all clinical laboratories in the United States will use the standardized Isotope Dilution Mass Spectrometry (IDMS) method to measure serum creatinine, which could result in an overestimation of the GFR in some patients with normal renal function. A carboplatin dose calculated from an estimated creatinine clearance based on an IDMS-measured serum creatinine could exceed exposure predicted by the Calvert formula and result in increased drug-related toxicity
Provided actual GFR measurements are made to assess renal function, carboplatin can be safely dosed according to the Calvert formula described in product labeling
If GFR (or Clcr) is estimated using serum creatinine measurements by the IDMS method, the FDA recommended for patients with normal renal function limiting estimated GFR (Clcr) to not more than 125 mL/min for any targeted AUC value
Calvert AH et al. J Clin Oncol 1989;7:1748–1756
Cockcroft DW, Gault MH. Nephron 1976;16:31–41
Jodrell DI et al. J Clin Oncol 1992;10:520–528
Sorensen BT et al. Cancer Chemother Pharmacol 1991;28:397–401
U.S. FDA. Carboplatin dosing. [online] October 8, 2010. Available from http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm228974.htm [accessed February 26, 2014]
Patient Population Studied
A study of 55 patients with carcinoma of unknown primary site were treated and available for assessment. Responding patients received 4 courses of treatment. The following histologies were included: adenocarcinoma (n = 30); poorly differentiated carcinoma or poorly differentiated adenocarcinoma (n = 21); poorly differentiated neuroendocrine carcinoma (n = 3); and squamous carcinoma (n = 1)