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Platinum-Based Chemotherapy Pregnancy: Contraindicated — cytotoxic and teratogenic

Cisplatin

Brand names: Cisplatin (generic)

Adult dose

Dose: 70 mg/m2 every 3 weeks (BEP regimen for testicular cancer); or 70 mg/m2 day 1 of GC regimen (bladder cancer)
Route: Intravenous infusion with aggressive IV hydration
Frequency: Every 3 weeks
Max: 70-100 mg/m2 per cycle depending on regimen
Requires aggressive pre- and post-hydration (2-3 litres normal saline with KCl and MgSO4). Highly emetogenic — mandatory 5HT3 antagonist + NK1 antagonist + dexamethasone pre-medication. Check eGFR before each cycle (must be above 50 mL/min)

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Contraindicated if eGFR under 50 mL/min — nephrotoxic; use carboplatin instead

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Cisplatin-based BEP (bleomycin, etoposide, cisplatin) is curative first-line treatment for metastatic testicular germ cell tumours — one of oncology's greatest success stories with over 95% cure rate in good-risk disease
  • Cisplatin eligibility criteria for bladder cancer: eGFR above 50, performance status 0-1, no neuropathy grade 2 or above, no heart failure — if ineligible, use carboplatin-based or pembrolizumab
  • Aggressive hydration is mandatory — without it, nephrotoxicity can be permanent and severe; target urine output above 100 mL/hr during infusion
  • Cumulative neurotoxicity: monitor carefully; can cause irreversible peripheral neuropathy — numbering scale used at each visit
  • Magnesium wasting is characteristic — monitor and replace; hypomagnesaemia can persist for months after treatment

Contraindications

  • eGFR under 50 mL/min
  • Pre-existing peripheral neuropathy (grade 2 or above)
  • Hearing impairment
  • Severe myelosuppression

Side effects

  • Nephrotoxicity (dose-limiting without adequate hydration)
  • Peripheral neuropathy (cumulative, dose-limiting)
  • Ototoxicity (high-frequency hearing loss, tinnitus)
  • Severe nausea and vomiting (most emetogenic cytotoxic)
  • Myelosuppression
  • Hypomagnesaemia, hypokalaemia
  • Alopecia

Interactions

  • Aminoglycosides (additive nephrotoxicity and ototoxicity — avoid)
  • Loop diuretics (additive ototoxicity)
  • Nephrotoxic drugs generally (additive risk)

Monitoring

  • eGFR before each cycle (must be above 50)
  • Electrolytes (Mg, K, Na)
  • Audiometry (cumulative ototoxicity)
  • Peripheral neuropathy assessment
  • FBC

Reference: BNFc; BNF 90; NICE NG127 (Testicular Cancer); EAU Testicular Cancer Guidelines 2024; EAU Bladder Cancer Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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