Division of Pediatric Oncology, Catholic University of Rome, Rome, Italy.
Anticancer Drugs. 2013 Nov;24(10):1007-19. 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.
铂类化合物广泛用于治疗儿科肿瘤，如神经母细胞瘤、生殖细胞肿瘤、骨肉瘤、视网膜母细胞瘤、肝母细胞瘤、脑肿瘤（低级别胶质瘤和髓母细胞瘤/原始神经外胚层肿瘤）以及复发性和难治性淋巴瘤。三种主要的铂类化合物（顺铂、卡铂和奥沙利铂）具有相似的药代动力学特征和作用机制，但它们化学结构的差异导致其抗肿瘤活性和毒性不同。在这篇综述中，我们描述了顺铂、卡铂和奥沙利铂的主要特征，重点介绍了它们的毒性作用和可能的预防策略，以改善儿科癌症患者的临床结局。每种铂类相关毒性的潜在机制与临床表现一起显示。此外，还提出了可能的预防策略，以减少铂类化合物对癌症儿童生活质量的负面影响。顺铂似乎主要引起耳毒性和肾毒性，卡铂主要引起骨髓抑制，而奥沙利铂则主要引起周围感觉神经毒性。相比之下，恶心和呕吐可能与所有铂类化合物有关，尽管顺铂的致吐作用最强。正确了解铂类化合物的药代动力学和毒理学特征可以帮助医生预防其对听觉、神经、肾脏和骨髓功能的毒性，从而提高儿科癌症患者的生活质量。
