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Platinol® is the brand name for a commonly-used chemotherapy drug called cisplatin. The U.S. Food and Drug Administration (FDA) initially approved cisplatin for cancer treatment in 1978. While the brand name product is no longer sold, it is currently manufactured as a generic medication by Bristol-Myers Squibb, Teva Pharmaceuticals, Tocris Biosciences, and many other pharmaceutical manufacturers.
Cisplatin is administered intravenously in cycles. It is a platinum-based chemotherapy drug that kills fast-growing cells. Cisplatin is a common treatment choice for mesothelioma; however, it is often used in combination with other drugs. It can cause serious side effects that must be carefully monitored.
What Is Cisplatin?
Cisplatin is a platinum-containing chemotherapy drug that specifically attacks fast-growing cells in the body. It is administered intravenously over several hours, but often only once every three to four weeks. Because cisplatin targets fast-growing cells, it kills cancer cells as well as healthy cells that grow and divide rapidly. Cisplatin causes cancer cells to die by binding to and distorting DNA, triggering cell death. Because this drug also affects healthy cells, it can lead to certain side effects. Patients are typically given as much of the drug as they can handle.
Cisplatin is used to treat several types of cancers, including cancers of the head and neck, bladder, breast, testicles, ovaries, cervix, lungs, brain, and mesothelioma. When first introduced in 1978, cisplatin was claimed to be a cure for testicular cancer. Although its discovery was accidental, the drug has saved countless lives and continues to be an important part of cancer research and clinical trials.
Combination Therapy with Cisplatin
Combining cisplatin with other medications has been a basic treatment approach for decades. Cisplatin is often combined with other drugs because as a single agent it may be effective for a limited period of time before the cancer becomes resistant to the drug. To combat this resistance, cisplatin is typically combined with doxorubicin, pemetrexed, and gemcitabine. In treating mesothelioma, combinations are often recommended because cisplatin alone has only a small response rate on mesothelioma tumors.
Cisplatin in Mesothelioma Treatment
Cisplatin can be used in several ways to treat mesothelioma patients. It may be used after surgery to clean up the cancer cells the surgeon could not physically remove. For patients who are poor candidates for surgery, cisplatin and other drugs can help slow the progression of the disease.
Combined with doxorubicin, cisplatin is often used for patients in advanced stages of mesothelioma. Used mainly for palliative care, this drug combination assists in relieving cancer symptoms and helping patients feel more comfortable. More recently, cisplatin has been combined with Alimta for mesothelioma patients. Clinical trials show that patients with mesothelioma live longer when given this combination than when receiving cisplatin alone.
Cisplatin has also been tested in combination with the chemotherapy drug gemcitabine for mesothelioma patients. An Australian clinical trial witnessed that about half of patients responded well to the combination. For these patients, survival time was extended by an average of ten months. A combination of radical surgery, radiation, and chemotherapy with cisplatin, doxorubicin and cyclophosphamide was found to significantly improve survival times for patients.
Common Side Effects
Because cisplatin kills rapidly-growing cells indiscriminately, it can cause a number of common side effects. Most of these side effects subside once chemotherapy treatment is complete. Side effects may include nausea, vomiting, hair loss, diarrhea, changes in taste, low red and white blood cell counts, hearing loss, and numbness and tingling in the fingers and toes.
To some extent, these side effects can be managed. For example, doctors may recommend a course of vitamin B12 supplements to avoid anemia and fatigue. All patients are also given anti-nausea medications while on a course of cisplatin. Alternative therapies like acupuncture and massage may also help patients cope with side effects.
Serious Side Effects
Cisplatin can also cause serious side effects. Any signs of these should be reported to a doctor immediately. Cisplatin carries a black box warning which is the FDA’s most severe warning label. A black box warning is used to ensure patients and doctors understand the potential for serious risk while using this medication.
One serious concern is kidney toxicity. The platinum in cisplatin can cause kidney damage in some patients, especially those with previous kidney problems. In order to reduce this risk, cisplatin is often administered with extra bags of IV hydration to assure that patients are urinating frequently during and immediately after a dose. Often, patients are also instructed to drink plenty of water after their dose. Patients on cisplatin who experience severe fatigue, decreased urination, or swelling in the legs, arms, feet, hands, or face should report these concerns to their doctor immediately.
Hearing loss is another possible serious issue. Cisplatin can cause permanent hearing loss, especially for children. Patients who experience ringing in the ears or reduced hearing volume should inform their provider with details of their concerns.
Patients on cisplatin should also watch for signs of infection, including chills, fever, bloody stool, bloody vomit, seizures, vision loss, eye pain, muscle cramps, and chest pains. Some people may have a severe reaction to cisplatin, which may include rash or irritation at the injection site, swelling in the face and mouth, difficulty breathing, hives, and dizziness. For some patients, the side effects of cisplatin can be severe. These patients may benefit from an alternative platinum chemotherapy like carboplatin or another medication that does not contain platinum.
For many patients with mesothelioma, cisplatin plays a key role in effective treatment and management of the disease. While the potential side effects can be uncomfortable or even severe, most patients tolerate the drug well. With continued research into cisplatin combinations with other drugs, even more patients could benefit from the positive effects of cisplatin.
Page Medically Reviewed and Edited by Kyle J. Becker, PharmD, MBA, BCOP
Kyle J. Becker, PharmD is certified by the Board of Pharmacy Specialties in Oncology Pharmacy. Dr. Becker earned his pharmacy degree from Shenandoah University and he currently serves as an oncology pharmacist at Parkview Cancer Institute.