Platinum Chemotherapy — Head and Neck Cancer
Pregnancy: Contraindicated — teratogenic and fetotoxic; effective contraception required during and for 6 months after treatment
Cisplatin
Brand names: Cisplatin Accord, Cisplatin Teva
Adult dose
Dose: Concurrent chemoradiation: 100 mg/m² IV every 3 weeks (3 cycles); or 40 mg/m² IV weekly. EXTREME regimen: 100 mg/m² day 1 every 3 weeks
Route: IV infusion (with aggressive pre- and post-hydration)
Frequency: Every 3 weeks (high-dose) or weekly (low-dose concurrent)
Max: 100 mg/m² per cycle
Cornerstone of head and neck cancer chemotherapy — concurrent with radiotherapy (CRT) for locally advanced HNSCC; EXTREME regimen with cetuximab + 5-FU for recurrent/metastatic disease. Requires 1–2L pre-hydration and post-hydration to prevent nephrotoxicity.
Paediatric dose
Dose: Seek specialist opinion mg/m²/kg
Route: IV
Frequency: Per specialist oncology protocol
Max: Not established as standard — specialist paediatric oncology use
Used in paediatric nasopharyngeal carcinoma and other HNC — specialist paediatric oncology input required
Dose adjustments
Renal
Avoid if eGFR <60 mL/min/1.73m² (standard dosing); carboplatin substituted if renal impairment
Hepatic
No dose adjustment established; use with caution
Paediatric weight-based calculator
Used in paediatric nasopharyngeal carcinoma and other HNC — specialist paediatric oncology input required
Clinical pearls
- Most emetogenic chemotherapy drug — requires aggressive antiemetic prophylaxis: ondansetron/granisetron + aprepitant (NK1) + dexamethasone + lorazepam
- Ototoxicity is cumulative and irreversible — baseline and serial audiometry mandatory; threshold shift in high frequencies (4–8 kHz) first
- Nephrotoxicity prevention: aggressive IV hydration (1–2L normal saline pre- and post-cisplatin); avoid aminoglycosides and NSAIDs; monitor creatinine and Mg²⁺
- Hypomagnesaemia is near-universal — replace magnesium before each cycle; can precipitate hypocalcaemia, hyponatraemia, and cardiac arrhythmias
- Carboplatin substituted when cisplatin contraindicated (renal impairment, neuropathy, poor ECOG performance status) — less nephrotoxic and ototoxic but more myelosuppressive
- Weekly low-dose cisplatin (40 mg/m²) better tolerated than 3-weekly 100 mg/m² — similar efficacy in concurrent CRT (RTOG 0522)
Contraindications
- eGFR <60 mL/min/1.73m²
- Pre-existing peripheral neuropathy
- Significant hearing impairment (sensorineural)
- Dehydration
- Pregnancy
Side effects
- Nephrotoxicity (dose-limiting — cumulative)
- Ototoxicity (sensorineural hearing loss — high-frequency, cumulative, irreversible)
- Peripheral neuropathy (cumulative)
- Myelosuppression
- Severe nausea/vomiting (highly emetogenic — requires 5HT3 antagonist + NK1 antagonist + dexamethasone)
- Hypomagnesaemia
- Hyponatraemia
- Alopecia
Interactions
- Aminoglycosides — additive nephrotoxicity and ototoxicity; avoid concurrent use
- Loop diuretics — additive ototoxicity
- NSAIDs — additive nephrotoxicity
Monitoring
- Renal function (before each cycle)
- Audiometry (before treatment and after each cycle)
- FBC
- Electrolytes (Mg²⁺, Na⁺, K⁺)
- Peripheral neuropathy assessment
Reference: BNFc; BNF 90; RTOG 0129; EXTREME Trial (Vermorken et al. NEJM 2008); NICE Guidance Head and Neck Cancer; SPC Cisplatin. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators