Cisplatin: What It Is and What to Expect

The US label for cisplatin is short. It covers advanced testicular cancer, advanced ovarian cancer and advanced bladder cancer. The National Cancer Institute lists the same three.

Cisplatin is used in many other cancers as well, including cancers of the head and neck, lung, cervix, esophagus and stomach. That use rests on trial evidence and treatment guidelines rather than on the label wording. It is common and it is proper practice. It is still fair to ask your team what the evidence is behind your own plan.

Cisplatin is hard on the kidneys, and water is the main defence. Expect a bag of fluid before the drug, more alongside it, and more afterwards. That is why a cisplatin day runs long. You may be asked to keep drinking for a couple of days at home and to keep passing urine.

Kidney blood tests and salts, magnesium in particular, are checked before each cycle. Tell the team about any other medicine that can strain the kidneys, including anti-inflammatory painkillers such as ibuprofen.

Four risks are named in the boxed warning.

• Kidney damage, which can be severe and builds up over cycles. Fluids and dose changes are how it is managed.
• Nerve damage in the hands and feet, which also gets worse with repeated courses.
• Severe sickness and vomiting, which is why strong anti-sickness medicine is always given first.
• Very low blood counts, which have led to fatal infections.

Cisplatin can damage hearing. The damage adds up over cycles and may not come back. It starts in the high frequencies, so the first sign is often ringing in the ears rather than obvious deafness. The label suggests checking hearing and balance. Children are more vulnerable than adults. Report ringing, muffled sound, or trouble following speech in a noisy room as soon as it starts.

Numbness and pins and needles in fingers and toes follow the same pattern. Struggling with buttons, keys, or feeling the floor underfoot all count. Saying so early gives the team room to adjust the dose before the change becomes permanent.

Bloods first, then anti-sickness medicine, then fluids, then the drug itself, then more fluids. Plan for most of a day and bring something to do.

Sickness can arrive a day or two later, so take the anti-sickness tablets you are sent home with on schedule rather than waiting to feel unwell. Eye problems, allergic reactions and, rarely, a second leukemia years later are also listed in the label. If a reaction to cisplatin has been severe, the label warns against trying it again, and notes that reactions can carry across to other platinum drugs.

• Call 911 or go to an emergency department if a rash, wheeze, throat tightness or faintness begins during or soon after the drip. The label warns against rechallenge after a severe reaction, and notes that reactions can carry across to other platinum drugs.
• Call your cancer team at once, at any hour, if your temperature reaches 100.4°F (38°C) or higher, or you get shaking chills and feel unwell. Very low counts on cisplatin have led to fatal infections, and CDC treats a fever during chemotherapy as a medical emergency rather than a next-morning phone call. If you cannot get through quickly, go to an emergency department and say on arrival that you are on cisplatin.
• Call your care team the same day if you stop passing urine, pass far less than usual, or cannot keep fluids down, since the kidneys depend on you staying flushed through.
• Call your care team within a day or two if your ears ring, sound goes muffled, or you lose the thread of speech in a noisy room. Report numbness or pins and needles in your hands and feet at the same point. Both build up over cycles and may not recover, so early word gives the team room to change the dose.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=508496cb-3441-46b3-a4fe-e0d440e6adc6

https://www.cancer.gov/about-cancer/treatment/drugs/cisplatin

https://www.cdc.gov/cancer-preventing-infections/patients/fever.html