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Platinum compounds in children with cancer: toxicity and clinical management

Ruggiero, Antonio; Trombatore, Giovanna; Triarico, Silvia; Arena, Roberta; Ferrara, Pietro; Scalzone, Maria; Pierri, Filomena; Riccardi, Riccardo

doi: 10.1097/CAD.0b013e3283650bda

Platinum compounds are widely used in the treatment of pediatric tumors such as neuroblastoma, germ-cell tumors, osteosarcoma, retinoblastoma, hepatoblastoma, brain tumors (low-grade gliomas and medulloblastoma/PNET), and relapsed and refractory lymphomas. The three major platinum compounds (cisplatin, carboplatin, and oxaliplatin) have a similar pharmacokinetics profile and mechanism of action, but the differences in their chemical structure are responsible for their different antitumor activity and toxicity. In this review, we have described the main characteristics of cisplatin, carboplatin, and oxaliplatin, focusing on their toxic effects and possible strategies to prevent them to improve the clinical outcomes in pediatric cancer patients. The underlying mechanism of each platinum-related toxicity is shown together with the clinical manifestations. Furthermore, possible preventive strategies are suggested to reduce the negative impact of platinum compounds on the quality of life of children with cancer. Cisplatin seems to be mostly ototoxic and nephrotoxic, carboplatin mainly produces myelosuppression, whereas oxaliplatin induces predominantly peripheral sensory neurotoxicity. In contrast, nausea and vomiting can be linked to all platinum compounds, although cisplatin exerts the strongest emetic effect. A correct knowledge of pharmacokinetics and toxicological profile of platinum compounds may aid physicians prevent their toxicity on auditory, nervous, renal, and bone marrow function, improving the quality of life of pediatric cancer patients.

Division of Pediatric Oncology, Catholic University of Rome, Rome, Italy

Correspondence to Antonio Ruggiero, Division of Pediatric Oncology, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy Tel: +39 06 3058203; fax: +39 06 3052751; e-mail:

Received June 4, 2013

Accepted July 12, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins