Cisplatin

Definition

Cisplatin, also known by the brand name Platinol-AQ, Cis-platinum, CDDP, or DDP, is a chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells.

Purpose

Cisplatin is approved by the Food and Drug Administration (FDA) to treat metastatic testicular cancer and metastatic ovarian cancer . It is also approved for late-stage bladder cancer and has been used to treat other types of cancer including head and neck cancer, esophageal cancer , stomach cancer , lung cancer, skin cancer, prostate cancer , lymphoma and others (breast, neuroblastoma , sarcoma, bladder, cervical, myeloma , mesothelioma , osteosarcoma ).

Description

Cisplatin is a member of the group of chemotherapy drugs known as heavy metal alkylating-like agents. These drugs interfere with the genetic material (DNA) inside the cancer cells and prevent them from further dividing and growing more cancer cells.

Cisplatin has been used to treat cancer for more than 30 years. It can be used alone or in combination with other chemotherapies, including bleomycin-etoposide, ifosfamide , gemcitabine , paclitaxel , fluorouracil-leucovorin, vinorelbine , methotrexate-vinblastine-doxorubicin. Cisplatin may also be given with radiation therapy .

Recommended dosage

A cisplatin dose can be determined using a mathematical calculation that measures body surface area (BSA), which depends on a person's overall size. Body surface area is measured in the units known as square meter (m²). The body surface area is calculated and then multiplied by the drug dosage in milligrams per m² (mg/m²), which gives the proper dosage.

Cisplatin is a clear, colorless solution administered by an infusion into a vein. Infusions can be given once every three to four weeks over a 30 minutes up to two hours. It can also be given continuously over 24 hours a day for several days in a row. One cycle of cisplatin should not be given more frequently than once every three to four weeks. Dosages depend on the cancer being treated.

To treat metastatic testicular cancer

Dosages are 20 mg/m² per day administered into a vein every day for five days in a row. This regimen is used in combination with other chemotherapy drugs, mainly bleomycin and etoposide or vinblastine .

To treat metastatic ovarian cancer

Dosages are 50 mg/m² to 100 mg/m² administered into a vein once every four weeks. This regimen can be combined with the chemotherapy drug cyclophosphamide or doxorubicin .

To treat advanced bladder cancer

Cisplatin doses range from 50 mg/m² to 70 mg/m² administered into a vein once every 3 to 4 weeks. Cisplatin is usually given alone for bladder cancer.

Before receiving cisplatin large volumes of intravenous fluids are given to keep the kidneys flushed with water. If patients have severe kidney problems the physician will either not use cisplatin or decrease the dose being used.

Normal metal ions found in the body, called electrolytes, can be lost due to administration of cisplatin. These may be added to these intravenous fluids for replacement.

Precautions

When receiving cisplatin, it is important to drink a lot of fluids to help flush the kidneys and prevent kidney damage. Patients also receive additional fluids through their veins before, during, and after receiving cisplatin.

Blood counts will be monitored regularly while on cisplatin therapy. During a certain time period after receiving cisplatin, there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to crowds and people with infections.

Patients with a known previous allergic reaction to chemotherapy drugs or any other medications should tell their doctor.

Patients who may be pregnant or trying to become pregnant should also tell their doctor before receiving cisplatin.

Chemotherapy can cause men and women to be sterile (not able to have children).

Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.

Side effects

Common side effects include nausea and vomiting , which can begin from 1 hour after receiving the drug and last as long as a week. Patients are given medicines known as antiemetics , before and after receiving cisplatin to help prevent or decrease this side effect. Diarrhea has also been known to occur.

A serious common side effect related to the total dose of cisplatin received is kidney damage, which can occur in up to one-third of patients. Taking fluids before, during and after receiving cisplatin help prevent this from occurring.

Hearing damage can also occur in up to one-third of patients. Patients may experience ringing in the ears and hearing loss of high-pitched frequency. Hearing tests may be requested before and/or after cisplatin therapy.

Low blood counts, referred to as myelosuppression , are expected due to cisplatin administration. When the white blood cell count is low this is called neutropenia and patients are at an increased risk of developing a fever and infections. Platelets are blood cells in the body that allow for the formation of clots. When the platelet count is low, patients are at an increased risk for bruising and bleeding. Low red blood cell counts, referred to as anemia , may also occur due to cisplatin administration. Low red counts make people feel tired.

Cisplatin can also cause damage to nerves and nervous system tissues. Patients may feel tingling, numbness and sometimes burning of the fingers and toes. This side effect is common and can be severe.

Less common side effects include change of taste sensation, loss of appetite, dizziness, seizures, confusion, muscle cramps and uncontrolled muscle contractions. Other side effects include, hair loss (alopecia ), hiccups, rash, allergic reactions with difficulty breathing, swelling and a fast heart rate.

Cisplatin may cause the body to waste normal electrolytes that circulate in the body (potassium, magnesium, phosphate, sodium, calcium) resulting in low levels of these electrolytes. These will be monitored by the doctor and replacement drugs will be given if necessary.

All side effects should be reported to the doctor or nurse.

Interactions

Patients should avoid other drugs that may cause damage to the kidneys.

Certain water pills and cisplatin given together may increase the risk of hearing damage. Before starting any medications, patients should notify their doctors.

Cisplatin may make medications that control seizures less effective.

Nancy J. Beaulieu, RPh., BCOP

KEY TERMS

Anemia

—A red blood cell count that is lower than normal.

Chemotherapy

—Specific drugs used to treat cancer.

DNA

—Genetic material inside of cells that carries information to make proteins that are necessary to run the cells and keep the body functioning properly.

Electrolytes

—Refers to the elements normally found in the body (sodium, potassium, calcium, magnesium, phosphorus, chloride, and acetate) that are important to maintain the many cellular functions and growth.

Food and Drug Administration

—A government agency that oversees public safety in relation to drugs and medical devices. The FDA gives approval to pharmaceutical companies for commercial marketing of their products.

Intravenous

—To enter the body through a vein

Metastatic

—Cancer that has spread to one or more parts of the body.

Neutropenia

—a white blood cell count that is lower than normal.

Radiation therapy

—The use of high-energy beams focused to treat cancerous tumors.

cisplatin (sis-plat-in) n. a platinum-containing compound: a cytotoxic drug that impedes cell division by damaging DNA. Administered intravenously, it is used in the treatment of testicular tumours and cancers of the head and neck; side-effects include nausea and vomiting, kidney damage, hearing loss, and peripheral neuropathy.