Cisplatin
PLATINOL
What it isPlatinum agent forming DNA crosslinks; testicular, ovarian, bladder and head and neck cancer.
Why this oneIt is curative in testicular cancer, one of the few solid tumors cured by chemotherapy.
What limits itCumulative nephrotoxicity requiring aggressive hydration, plus irreversible ototoxicity and peripheral neuropathy. Severe emesis needs triple antiemetics.
FDA-approved for
- cancer (1978)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Advanced testicular cancer | Adult | 20 mg/m2 IV daily x5 days per cycle | ||
| Advanced ovarian cancer | Adult | 75-100 mg/m2 IV once every 3-4 weeks | ||
| Advanced bladder cancer | Adult | 50-70 mg/m2 IV once every 3-4 weeks (heavily pretreated: 50 mg/m2 q4wk) |
Renal Consider alternative treatment or dose reduction for baseline renal impairment or significant fall in creatinine clearance (per clinical treatment guidelines)
Hepatic Undefined
Instructions
- Give pre-treatment IV hydration; maintain hydration and urine output for 24 h after dosing
- Premedicate with antiemetics (highly emetogenic); consider additional antiemetics for delayed emesis
- Do not use aluminum-containing needles or IV sets (precipitate forms, loss of potency)
- Administer by slow IV infusion; monitor site (extravasation causes tissue toxicity)
Cautions
- Severe hypersensitivity/anaphylaxis; cross-reactivity among platinum agents
- Ototoxicity (cumulative; more severe in pediatric patients <5 y)
- Ocular toxicity (optic neuritis, papilledema, cortical blindness)
- Secondary acute leukemia
- Embryo-fetal toxicity; use effective contraception
- Injection-site reactions/extravasation tissue injury
- Electrolyte wasting (hypomagnesemia, hypokalemia); SIADH
Adverse reactions
- Nephrotoxicity
- Peripheral neuropathy
- Nausea and vomiting
- Myelosuppression
- Ototoxicity
Pregnancy Can cause fetal harm (human data): transplacental transfer, oligohydramnios, intrauterine growth restriction, preterm birth; neonatal cytopenias and hearing loss reported.
Lactation Present in human milk in low amounts; advise not to breastfeed during treatment.
⚠ BOXED WARNINGS
- Nephrotoxicity
- Ototoxicity
- Myelosuppression
- Severe nausea and vomiting
Cost, est. cash$50–$10,000/month or cycle
Generic entry1999
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySevere nephrotoxicity, ototoxicity, neuropathy and emesis require intensive supportive care.
Mechanism of action: Cisplatin ballicule
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Memory aids: mascots and interaction avatars
"Cis" meaning "on this side"
"Platin" for platinum → platinum-based alkylating-like agent
