Niveau de preuve du suivi thérapeutique pharmacologique du carboplatine

Carboplatin is an anticancer agent widely used in different types of cancer in adults and paediatrics patients. Carboplatin undergoes an high protein binding percentage in plasma and presents a major hematotoxicity. Some studies determined unbound and bound platin concentrations using flameless atomic absorption spectrophotometry or chromatography. These studies showed a relationship between carboplatin exposition expressed using AUC of ultrafiltrable concentrations with time and myelotoxicity. However, the relationship between carboplatin exposition and its efficacy is not yet established. The population approach using a nonlinear mixed effects model showed a low variability of drug exposition parameters. In some cases, Bayesian adaptative dosing were proposed. However, some particular populations will have to be taken into account such as intensive doses of carboplatin, children, patients with hemodialysis-dependant renal insufficiency or obese patients. Therapeutic carboplatin monitoring is today recommended measuring AUC ultrafiltrable concentrations in time and using described ajusted-modelling.