Cisplatin in Cancer Treatment: Recommended Uses and Dosages
Cisplatin is a platinum-based chemotherapeutic agent used in various cancer types with specific dosing regimens that vary by cancer type, with the most common dosages ranging from 50-100 mg/m² administered intravenously every 3-4 weeks. 1
Cancer-Specific Dosing Regimens
Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
Intraperitoneal (IP)/Intravenous (IV) Regimen (Category 1):
- Paclitaxel 135 mg/m² IV continuous infusion over 3 or 24 hours on Day 1
- Cisplatin 75-100 mg/m² IP on Day 2 after IV paclitaxel
- Paclitaxel 60 mg/m² IP on Day 8
- Repeat every 3 weeks for 6 cycles 2
For metastatic ovarian tumors:
- As single agent: 100 mg/m² IV per cycle once every 4 weeks
- With cyclophosphamide: 75-100 mg/m² IV once every 4 weeks (Day 1) 1
Testicular Cancer
- 20 mg/m² IV daily for 5 days per cycle in combination with other approved chemotherapeutic agents 1
Bladder Cancer
- Single agent: 50-70 mg/m² IV per cycle once every 3-4 weeks
- For heavily pretreated patients: 50 mg/m² per cycle repeated every 4 weeks 1
Nasopharyngeal Carcinoma
Concurrent with radiotherapy:
- Weekly: 40 mg/m² for 6-7 cycles
- Triweekly: 100 mg/m² every 3 weeks for 2-3 cycles
- Cumulative dose of at least 200 mg/m² recommended for efficacy 2
Induction chemotherapy regimens:
- TPF: Cisplatin 60-75 mg/m² day 1 with docetaxel and 5-fluorouracil
- GP: Cisplatin 80 mg/m² day 1 with gemcitabine
- PF: Cisplatin 80-100 mg/m² day 1 with 5-fluorouracil 2
Thymomas and Thymic Carcinomas
- First-line combination regimens:
- CAP: Cisplatin 50 mg/m² IV day 1 with doxorubicin and cyclophosphamide
- ADOC: Cisplatin 50 mg/m² IV day 1 with doxorubicin, vincristine, and cyclophosphamide 2
Malignant Germ Cell Tumors
- BEP regimen: Cisplatin 20 mg/m² daily for days 1-5 with bleomycin and etoposide 2
Administration Guidelines
Preparation and Administration
- Administer by slow intravenous infusion over 6-8 hours
- NEVER give by rapid intravenous injection
- Do not use needles or IV sets containing aluminum parts (causes precipitation)
- Dilute in 2 liters of 5% Dextrose in 1/2 or 1/3 normal saline containing 37.5 g of mannitol 1
Hydration Protocol
- Pretreatment hydration with 1-2 liters of fluid infused for 8-12 hours prior to cisplatin dose
- Maintain adequate hydration and urinary output during the following 24 hours to reduce nephrotoxicity 1, 3
Monitoring and Dose Adjustments
Required Monitoring
- Renal function: Serum creatinine should be below 1.5 mg/100 mL and BUN below 25 mg/100 mL before repeat courses
- Hematologic parameters: Platelets ≥100,000/mm³, WBC ≥4,000/mm³
- Audiometric analysis to ensure auditory acuity is within normal limits
- Electrolytes: Monitor magnesium, calcium, and potassium levels 3, 1
Managing Toxicities
Common Toxicities
- Nephrotoxicity (dose-limiting)
- Ototoxicity
- Neurotoxicity
- Myelosuppression
- Nausea and vomiting
- Electrolyte disturbances 3, 4, 5
Special Considerations
- For patients with borderline renal function, split-dose administration may be considered
- Elderly patients require closer monitoring due to higher susceptibility to nephrotoxicity
- Do not substitute carboplatin for cisplatin in perioperative settings where cisplatin has proven efficacy 3
Clinical Pearls
- Cisplatin is more effective than carboplatin for certain indications and should not be routinely substituted with carboplatin in the adjuvant setting 2
- For ovarian cancer, intraperitoneal cisplatin has shown a 16-month survival advantage compared to standard intravenous therapy in optimally debulked disease 2
- The combination of cisplatin with vinorelbine has shown significant survival benefits in non-small cell lung cancer 2
- Cisplatin exerts its cytotoxic effect by forming intra-strand DNA adducts, inhibiting DNA synthesis and cell growth 6, 5
Remember that cisplatin administration requires careful attention to hydration protocols and monitoring of renal function to minimize toxicity while maintaining efficacy.