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Platinum Chemotherapy — Head and Neck Cancer Pregnancy: §4.6: there are no adequate data in pregnant women, but based on its pharmacological properties cisplatin is suspected to cause serious birth defects; animal studies have shown reproductive toxicity. Cisplatin should not be used during pregnancy unless the clinician considers the risk to the individual patient to be justified. During treatment and for a minimum of the following 6 months, appropriate measures must be taken to avoid pregnancy — this applies to patients of both sexes; genetic consultation is recommended if the patient wishes to have children after ending treatment. Contraindicated during breast-feeding. Treatment may cause irreversible infertility — men who wish to become fathers should seek advice on sperm cryoconservation before treatment.

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.

Adult dose

Dose: Advanced or metastasised squamous cell carcinoma of the head and neck — a licensed indication of this product (§4.1). §4.2 doses by regimen type rather than by tumour site: 'The cisplatin dosage depends on the primary disease, the expected reaction, and on whether cisplatin is used for monotherapy or as a component of combination chemotherapy.' MONOTHERAPY, two recommended regimens: a 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. COMBINATION THERAPY: the dose of cisplatin must be reduced — a typical dose is 20 mg/m² or more once every 3 to 4 weeks. Reduce the dose adequately in renal dysfunction or bone marrow depression. This SPC gives no head-and-neck-specific and no chemoradiotherapy regimen, and none has been inferred.
Route: Intravenous infusion over a period of 6 to 8 hours, after dilution of the concentrate. HYDRATION is mandatory: maintain from 2 to 12 hours before administration until at least 6 hours after. Pre-treatment — IV infusion of 100 to 200 ml/hour for 6 to 12 hours, total at least 1 litre. After administration — a further 2 litres at 100 to 200 ml/hour over 6 to 12 hours. Forced diuresis may be required if urine secretion is less than 100 to 200 ml/hour after hydration, and mannitol or a diuretic is also required whenever the administered dose is higher than 60 mg/m² of BSA. The patient must drink large quantities of liquid for 24 hours after the infusion. Any device containing aluminium that may contact cisplatin (IV sets, needles, catheters, syringes) must be avoided.
Frequency: Every 3 to 4 weeks (or daily for five days, repeated every 3 to 4 weeks). §4.4: cisplatin should not be given more frequently than once every 3-4 weeks.
Administer only under the direction of oncologists in specialist units, with equipment available to control anaphylactic reactions; do not mix the infusion with other drugs or additives. §4.2 states no maximum dose for this indication, so none is given here — the 120 mg/m² figure above is the top of a recommended monotherapy range, not a printed ceiling, and has deliberately not been carried into the maximum field. §4.2 also contains a weekly combination regimen, but that paragraph is for cervical cancer — a different indication — and is deliberately not carried onto this page. Repeat administration should be postponed until serum creatinine ≤130 μmol/l (1.5 mg/100 ml), urea <25 mg/dl, white cells >4000/μl, platelets >100000/μl and the audiogram is within the normal range. Although usually given intravenously, §4.2 notes cisplatin has also been given by intraperitoneal instillation for intraperitoneal malignancies — not a route for this page.

Paediatric dose

Dose: No separate paediatric figure is printed. §4.2 opens 'Adults and paediatric population' and states 'The dosage directions are applicable for both adults and children' — i.e. the adult regimens above. Nothing has been scaled or derived.
Route: Intravenous infusion over 6 to 8 hours, with the same hydration regimen
Frequency: Every 3 to 4 weeks, as for adults
§4.4 and §4.8 warn that the ototoxic effect may be more pronounced in children and that ototoxicity may be more severe in children. Use only under specialist paediatric oncology direction and against the treating unit's protocol; verify against a children's formulary.

Dose adjustments

Renal

§4.2: in patients with renal dysfunction the dose should be reduced adequately (no numeric reduction is stated). §4.3: contraindicated in pre-existing renal impairment. §4.4: nephrotoxicity is severe and cumulative and may be potentiated by aminoglycosides; measure BUN, serum creatinine or GFR/creatinine clearance before therapy and before each subsequent course; do not give a repeat course unless serum creatinine is below 130 μmol/l (1.5 mg/100 ml) and blood urea below 25 mg/100 ml (9 mmol/l). A urine output of 100 ml/hour or greater tends to minimise nephrotoxicity.

Hepatic

No numeric hepatic dose adjustment is stated in this SPC. §4.4 requires hepatic function to be determined before, during and after administration and monitored at regular intervals.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to cisplatin, to any of the excipients, or to other platinum containing compounds
  • Pre-existing renal impairment (cisplatin nephrotoxicity is cumulative)
  • Pre-existing hearing impairment (cisplatin is cumulatively neurotoxic, in particular ototoxic)
  • Myelosuppression
  • Dehydration
  • Breast-feeding
  • Concurrent administration of yellow fever vaccine

Side effects

  • SCOPE: §4.8 was cut off at the source-fetch limit in this bundle, so the list below is partial — it is not the complete adverse-effect profile
  • Haematological — bone marrow failure, thrombocytopenia, leukopenia, anaemia (all very common); Coombs positive haemolytic anaemia (not known)
  • Renal — renal failure, nephrotoxicity, hyperuricaemia; serious toxic effects on kidneys, bone marrow and ears reported in up to about one third of patients given a single dose
  • Ototoxicity (uncommon); tinnitus and deafness (not known) — may be more severe in children
  • Gastrointestinal — anorexia, nausea, vomiting and diarrhoea among the most frequently reported events
  • Hyponatraemia (very common); hypomagnesaemia (uncommon); dehydration, hypokalaemia, hypophosphataemia, hyperuricaemia, hypocalcaemia, tetany (not known)
  • Inappropriate antidiuretic hormone secretion (SIADH) (not known)
  • Peripheral neuropathies, convulsion, leukoencephalopathy, reversible posterior leukoencephalopathy syndrome (rare); cerebrovascular accident, haemorrhagic and ischaemic stroke, ageusia, myelopathy, autonomic neuropathy (not known)
  • Anaphylactoid reaction (uncommon); cross-reactions, sometimes fatal, reported with all platinum compounds
  • Cardiac — arrhythmia, bradycardia, tachycardia (common); myocardial infarction (rare); cardiac arrest (very rare)
  • Venous thromboembolism (common); thrombotic microangiopathy / haemolytic uraemic syndrome and Raynaud's phenomenon (not known)
  • Sepsis (common); infection (not known); fever
  • Acute leukaemia (rare)
  • Ocular — vision blurred, acquired colour blindness, cortical blindness, optic neuritis, papilloedema, retinal pigmentation (not known)

Monitoring

  • Before, during and after administration, and repeated every week throughout treatment: renal function; hepatic function; haematopoietic function (red cells, white cells, platelets); serum electrolytes (calcium, sodium, potassium, magnesium)
  • Before each repeat course, confirm serum creatinine ≤130 μmol/l (1.5 mg/100 ml), urea <25 mg/dl, white cells >4000/μl, platelets >100000/μl and a normal-range audiogram
  • Audiometry before initiating therapy, repeated when auditory symptoms occur or clinical hearing changes become apparent — deterioration may require dose modification or discontinuation
  • Neurological examination at regular intervals — severe neuropathies may be irreversible
  • Urine output during and after treatment (target 100 ml/hour or greater); measure BUN, serum creatinine or GFR/creatinine clearance before therapy and before each course
  • Verify clarity of the solution and absence of particles before administration; watch for hypersensitivity during the infusion

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).

Related

Curated clinical cross-links plus same-class fallbacks.

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