II. Indications (Part of combination protocols)
- FDA approved
- Metastatic Testicular Cancer
- Metastatic Ovarian Cancer
- Bladder Cancer
- Off-Label Use - Adults
- Cervical Cancer
- Endometrial Cancer
- Esophageal Cancer
- Gastric Cancer
- Head and neck cancer
- Lung Cancer (Non-small cell and small cell)
- Sarcoma
- Off-Label Use - Children
- Germ cell tumors
- Hepatoblastoma
- Medulloblastoma
- Neuroblastoma
- Osteosarcoma
III. Mechanism
- First-generation platinum based, alkylating antineoplastic agent
- Inorganic, water based compund
- Derived drugs include Carboplatin
- Components
- Platinum atom
- Ammonia groups (2)
- Activated via hydrolysis intracellularly to highly reactive, charged platinum complexes
- Binds DNA (e.g. GC rich regions)
- Results in DNA cross-links
- Results in cell growth inhibition (G2 cell cycle arrest), apoptosis and cell death
- Unique features
- Penetrates Testes barrier
- Partially penetrates blood brain barrier
IV. Medications
- Cisplatin IV Solution (1 mg/ml): 50 ml, 100 ml or 200 ml
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
- Alopecia
- Anaphylaxis
- Bone Marror Suppression
- Electrolyte abnormalities
- Hepatotoxicity
- Hyperuricemia
- Optic Neuritis (as well as Papilledema, cerebral blindness)
-
Ototoxicity
- May be irreversible
- Higher risk in patients with TMPT gene variant (thiopurine-S-Methyltransferase)
- Myalgias
- Nephrotoxicity
- Reduced when amifostine is added to Ovarian Cancer regimen
- Peripheral Neuropathy
- Secondary Malignancy
- Vomiting (excessive)
VII. Safety
- Avoid in Lactation
- Pregnancy Category D
- Avoid in Pregnancy (all trimesters)
- Use reliable Contraception
- Age >65 years
- Increased risk of nephrotoxicity, Bone Marrow suppression, Peripheral Neuropathy
- Monitoring
VIII. Drug Interactions
-
Phenytoin
- Cisplatin decreases levels
-
Aminoglycosides
- Increased risk of nephrotoxicity
IX. Resources
- Cisplatin (DailyMed)
- Cisplatin (StatPearls)