Carboplatin May Be an Effective and Tolerable Treatment Option for Platinum-Sensitive Pancreatic Cancer Patients With Pre-existing Neuropathy.

Platinum-based chemotherapy remains an important component of treatment for pancreatic adenocarcinoma; however, cumulative neurotoxicity from oxaliplatin and cisplatin often limits continued therapy. Carboplatin is a less neuropathic platinum analogue with activity in other malignancies, but it is not approved for pancreatic cancer. We describe a patient with pancreatic adenocarcinoma who achieved prolonged disease stability on carboplatin after discontinuation of oxaliplatin due to neuropathy. A 57-year-old woman presented with pancreatic adenocarcinoma and was treated with neoadjuvant FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, irinotecan), chemoradiation, and pancreaticoduodenectomy, followed by adjuvant gemcitabine and capecitabine. Over time, she developed suspected locoregional recurrence and received multiple subsequent systemic therapies, including FOLFIRINOX rechallenge, 5-fluorouracil with liposomal irinotecan, and gemcitabine with nab-paclitaxel. These regimens were limited by intolerance, disease progression, and worsening peripheral neuropathy. Given progression on non-platinum regimens and increasing neuropathy, but prior disease control with oxaliplatin, the patient was started on carboplatin. Initial imaging showed improvement in ascites and stabilization of retroperitoneal disease. She experienced radiographically stable disease for 13 cycles over approximately 10 months without worsening neuropathy before eventual disease progression. This case suggests that carboplatin may be a reasonable option for select patients with pancreatic adenocarcinoma who appear to benefit from platinum therapy but cannot tolerate oxaliplatin or cisplatin due to neuropathy. While clinical data are limited, prior studies have demonstrated modest efficacy and a favorable toxicity profile with carboplatin-based regimens. Carboplatin may warrant consideration as an alternative platinum agent or as a switch-maintenance strategy in patients with platinum sensitivity and cumulative neuropathy.