What are the side effects of cisplatin (Platinol) chemotherapy?

From the Guidelines

Cisplatin chemotherapy is associated with significant side effects, including ototoxicity, nephrotoxicity, peripheral neuropathy, bone marrow suppression, and electrolyte imbalances, which can impact morbidity, mortality, and quality of life. The most recent and highest quality study 1 highlights the risk of ototoxicity, with cisplatin causing irreversible damage to the outer hair cells of the cochlea, resulting in bilateral sensorineural hearing loss in 20%–75% of patients.

Key Side Effects

• Ototoxicity: bilateral sensorineural hearing loss, tinnitus, and damage to the outer hair cells of the cochlea 1
• Nephrotoxicity: kidney damage requiring adequate hydration before and after treatment with IV fluids 1
• Peripheral neuropathy: tingling or numbness in hands and feet, sometimes persisting after treatment ends 1
• Bone marrow suppression: decreased blood cell counts, increasing infection risk and causing fatigue 1
• Electrolyte imbalances: low magnesium, potassium, and calcium levels requiring monitoring and supplementation 1

Management

• Antiemetics like ondansetron before treatment to prevent nausea and vomiting
• Kidney function monitoring and adequate hydration to prevent nephrotoxicity
• Hearing tests to detect ototoxicity
• Blood count checks throughout therapy to monitor bone marrow suppression
• Electrolyte supplementation to prevent imbalances It is essential to prioritize these side effects and manage them effectively to minimize their impact on patients' morbidity, mortality, and quality of life. The study by 1 provides the most recent and highest quality evidence, and its findings should be considered when making clinical decisions.

From the FDA Drug Label

Elderly patients may be more susceptible to nephrotoxicity (see PRECAUTIONS, Geriatric Use). Impairment of renal function has been associated with renal tubular damage. Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m 2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4,000 to 8,000 Hz). Myelosuppression occurs in 25% to 30% of patients treated with cisplatin. Marked nausea and vomiting occur in almost all patients treated with cisplatin, and may be so severe that the drug must be discontinued. Anaphylactic-like reactions have been reported in patients previously exposed to cisplatin. Hepatotoxicity Transient elevations of liver enzymes, especially SGOT, as well as bilirubin, have been reported to be associated with cisplatin administration at the recommended doses Other Events Cardiac abnormalities, hiccups, elevated serum amylase, rash, alopecia, malaise, asthenia, and dehydration have been reported.

The side effects of cisplatin (Platinol) chemotherapy include:

• Nephrotoxicity: damage to the kidneys, especially in elderly patients
• Ototoxicity: hearing loss, tinnitus, and deafness, especially in children
• Myelosuppression: low blood cell counts, including anemia, leukopenia, and thrombocytopenia
• Gastrointestinal toxicity: nausea, vomiting, diarrhea, and anorexia
• Anaphylactic-like reactions: facial edema, wheezing, tachycardia, and hypotension
• Hepatotoxicity: elevated liver enzymes and bilirubin
• Other events: cardiac abnormalities, hiccups, elevated serum amylase, rash, alopecia, malaise, asthenia, and dehydration 2 2 2

From the Research

Side Effects of Cisplatin Chemotherapy

The side effects of cisplatin chemotherapy are numerous and can significantly impact a patient's quality of life. Some of the most common side effects include:

• Nephrotoxicity (kidney damage) 3, 4
• Neurotoxicity (nerve damage) 3, 4
• Ototoxicity (hearing loss) 3, 4
• Nausea and vomiting 3, 5, 6, 4, 7
• Anaphylaxis (severe allergic reaction) 4
• Cytopenias (low blood cell count) 4
• Hepatotoxicity (liver damage) 4
• Cardiotoxicity (heart damage) 4
• Diarrhea 4
• Mucositis (mouth sores) 4
• Stomatitis (inflammation of the mouth) 4
• Pain 4
• Alopecia (hair loss) 4
• Anorexia (loss of appetite) 4
• Cachexia (weight loss and muscle wasting) 4
• Asthenia (weakness and fatigue) 4

Management of Side Effects

Several approaches have been developed to reduce or prevent the side effects of cisplatin chemotherapy, including:

• Use of antiemetics such as ondansetron, granisetron, and tropisetron to control nausea and vomiting 5, 6, 7
• Use of amifostine, vitamin E, and silymarin to reduce nephrotoxicity and other side effects 3
• Use of NK-1 receptor antagonists to control nausea and vomiting 3
• Administration of additional non-chemotherapy based drugs to treat side effects, such as antibiotics and myeloid growth factors 4