How is cisplatin (cis-diamminedichloroplatinum) administered in cervical cancer treatment?

From the Guidelines

Cisplatin in cervical cancer treatment is typically administered intravenously as part of combination chemotherapy regimens, with a standard dose of 40 mg/m² once weekly for 5-6 weeks during radiation therapy (concurrent chemoradiation) 1. The administration of cisplatin is crucial in the treatment of cervical cancer, particularly in stages IB2, II, III, and IVA disease, where concurrent chemoradiation has shown a 30% to 50% decrease in the risk of death compared with radiation therapy alone 1. Key points to consider when administering cisplatin include:

• The use of adequate hydration with intravenous fluids to minimize kidney damage
• The administration of antiemetics such as ondansetron and dexamethasone to prevent severe nausea and vomiting
• Regular monitoring of kidney function, electrolytes, hearing, and blood counts during treatment
• The consideration of concurrent single-agent cisplatin chemoradiation as a preferred option due to lesser toxicity compared to cisplatin/fluorouracil chemoradiation 1 Cisplatin works by forming DNA crosslinks in cancer cells, preventing DNA replication and triggering apoptosis, and is particularly effective when combined with radiation therapy as it acts as a radiosensitizer, enhancing the DNA-damaging effects of radiation specifically in cancer cells. According to the NCCN clinical practice guidelines in oncology, concurrent cisplatin-containing chemoradiation improves progression-free survival and overall survival when compared with radiation therapy with or without hydroxyurea 1. It is essential to note that while chemoradiation is tolerated, acute and long-term side effects have been reported, and concurrent carboplatin or non-platinum chemoradiation regimens are options for patients who may not tolerate cisplatin-containing chemoradiation 1.

From the Research

Administration of Cisplatin in Cervical Cancer Treatment

• Cisplatin is typically administered intravenously in combination with concurrent radiation therapy for the treatment of local and regional cervical cancer 2.
• The standard dose of cisplatin is usually 40 mg/m2, administered weekly, although some studies have used doses of 30 mg/m2 for patients over 65 years old 3, 4.
• Cisplatin can be administered concurrently with external beam radiation therapy and high-dose-rate intracavitary brachytherapy 3, 4.
• Some studies have explored the use of localized delivery systems, such as polymeric implants, to deliver cisplatin directly to the tumor, reducing systemic side effects 2.

Comparison with Carboplatin

• Some studies have compared the efficacy and toxicity of cisplatin with carboplatin in the treatment of locally advanced cervical cancer 5, 6.
• These studies have found that carboplatin may be an alternative to cisplatin, with similar overall survival and progression-free survival rates, as well as similar overall response rates and toxic effects 5, 6.
• However, carboplatin may be associated with better compliance rates and less toxicity, such as anemia, neutropenia, and nephrotoxicity, compared to cisplatin 6.

Toxicity and Side Effects

• Cisplatin can cause significant systemic toxicities, including hematological, gastrointestinal, and renal toxicity 3, 4.
• The incidence of severe acute hematological toxicity was found to be higher in patients receiving 40 mg/m2 of cisplatin compared to those receiving 30 mg/m2 4.
• Localized delivery systems, such as polymeric implants, may help to reduce systemic side effects and improve the therapeutic efficacy of cisplatin 2.