Cisplatin

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.