Platinum Chemotherapy — Head and Neck Cancer Pregnancy: No adequate data in pregnant women; suspected to cause serious birth defects and animal studies show reproductive toxicity. Should not be used during pregnancy unless the clinician considers the risk justified. Effective contraception required in both sexes during and for at least 6 months after treatment. Contraindicated during breast-feeding.

Cisplatin

Brand names: Cisplatin Accord, Cisplatin Teva

Cisplatin is an intravenous platinum-based cytotoxic used, often with radiotherapy, in the treatment of head and neck squamous cell carcinoma and other solid tumours.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Monotherapy: single dose of 50 to 120 mg/m2 body surface every 3 to 4 weeks; OR 15 to 20 mg/m2/day for five days, every 3 to 4 weeks

Route: Intravenous infusion (over 6 to 8 hours)

Frequency: Every 3 to 4 weeks (single-dose regimen) or daily for 5 days per cycle

Max: Monotherapy single dose up to 120 mg/m2 every 3 to 4 weeks (per SPC regimen)

ENT/head-and-neck oncology context. Dose depends on primary disease, expected response, and whether used as monotherapy or in combination; directions apply to adults and children. In combination chemotherapy the cisplatin dose must be reduced (typical dose 20 mg/m2 or more once every 3-4 weeks). For cervical cancer, used with radiotherapy/other chemotherapeutics at a typical dose of 40 mg/m2 weekly for 6 weeks. Must be given only under the direction of oncologists in specialist units. Mandatory hydration from 2-12 hours before until at least 6 hours after administration (IV sodium chloride 0.9% or 0.9% saline/5% glucose 1:1); forced diuresis with mannitol required when dose exceeds 60 mg/m2. Should not be given more frequently than once every 3-4 weeks. Avoid all aluminium-containing IV sets/needles/syringes. Do not repeat courses until serum creatinine <130 micromol/L (1.5 mg/100 mL), urea acceptable, WBC >4000/microL, platelets >100000/microL, and audiogram normal.

Dose adjustments

Renal

Contraindicated in pre-existing renal impairment. In renal dysfunction the dose should be reduced adequately. Do not repeat courses until serum creatinine is below 130 micromol/L (1.5 mg/100 mL) and blood urea below 25 mg/100 mL (9 mmol/L).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to cisplatin, other platinum-containing compounds, or any excipient
Pre-existing renal impairment (nephrotoxicity is cumulative)
Pre-existing hearing impairment (cumulatively ototoxic)
Myelosuppressed patients and dehydrated patients
Breast-feeding; concurrent yellow fever vaccine

Side effects

Haematological: bone marrow failure, thrombocytopenia, leukopenia, anaemia (very common)
Gastrointestinal: nausea, vomiting, anorexia, diarrhoea
Ototoxicity / hearing impairment (may be more severe in children)
Nephrotoxicity / renal failure, hyperuricaemia
Hyponatraemia (very common); fever

Interactions

Aminoglycoside antibiotics (potentiate nephrotoxicity)
Other potentially nephrotoxic drugs (special care required)
Yellow fever vaccine (contraindicated concurrently)

Clinical monograph

How it works

It forms platinum-DNA cross-links that disrupt DNA replication and transcription, triggering apoptosis of dividing tumour cells.

Prescribing in practice

Cisplatin is markedly nephrotoxic and ototoxic, and adequate intravenous hydration (with attention to electrolytes) is mandatory to limit renal damage, while baseline and ongoing assessment of renal function and hearing is required.
It is intensely emetogenic and requires guideline-based antiemetic prophylaxis, and it causes cumulative peripheral neuropathy and myelosuppression.
It is given under specialist oncology supervision with electrolyte monitoring, as hypomagnesaemia and other disturbances are common.

Monitoring

Monitor renal function, full blood count, electrolytes (including magnesium) and hearing, and assess for neuropathy before and during treatment.

Counselling the patient

Report new ringing in the ears or hearing changes promptly.
Nausea and tingling in the hands or feet should be reported to the team.
Plenty of fluids and blood tests are part of treatment to protect the kidneys.

Evidence & guidelines

Concurrent cisplatin-based chemoradiotherapy is a standard-of-care option for locally advanced head and neck cancer in oncology guidelines.

Reference: RTOG 0129; EXTREME Trial (Vermorken et al. NEJM 2008); NICE Guidance Head and Neck Cancer; SPC Cisplatin; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways