The Penicillin of Cancer

Treating Cancer With Cisplatin

Cisplatin is usually administered intravenously. The nurse or technician will hook up a bag to your arm; the cisplatin is dissolved in salt water - the saline solution common to many drug deliveries. The patient is hooked up to the bag for a half hour to two hours and cisplatin drips in at approximately 1 mg/minute; the infusion rate and regimen is established by the oncologist. Depending on the type and location of the tumor, cisplatin can be given by intra-arterial and intraperitoneal methods. Cisplatin is not given orally and would not work if given orally. It is not given dermally.

Treatment of ovarian cancer involves putting the cisplatin into the peritoneal cavity rather than a blood vessel. The type and extent of a cancer determines the exact dose and schedule of administering the drug. Intraperitoneal administration generally results in a lower peak blood plasma concentration of the drug than intravenous administration does.

The patient is typically given one to two liters of saline solution before the drug is injected. After administration, patients are given more saline solution intravenously and advised to maintain adequate water consumption for a day. Problems with urination (or no urination) should be reported to the doctor.

How long does it take for the cisplatin to get to the tumor? It depends on the administration method and which organ the tumor is in. The peak concentration in the kidney occurs a few hours after infusion, while the liver, testes, and intestines don't get their peaks until a couple days after administration.

The drug companies supply oncology clinics with cisplatin as a powder or as a 1 mg/mL solution (1000 ppm). The preparation usually contains salt and a diuretic such as mannitol. The technician at the clinic mixes the cisplatin into a saline solution appropriate for administration to the body.

Before taking cisplatin, tell your doctor and pharmacist if you are allergic to any platinum-containing compounds such as carboplatin (aka Paraplatin), or to any other drugs. Also tell your health care team about prescription and nonprescription medications you are taking.

Cisplatin does some weird things with your bodily fluids. While being treated, drink plenty of fluids because this drug can irritate your kidneys. Tell your doctor if you have ever had kidney disease before. The platinum drug also passes into breast milk, so don't breast feed.

Cisplatin may interfere with the normal menstrual cycle in women and may stop sperm production in men.

Questions related to your treatment that you can ask your doctor include:

  • What is the total number of treatments that I will receive?
  • Which drugs or drug combinations will be used? Cisplatin is very often used as part of a combination chemotherapy regimen.
  • Where will the treatment be administered (hospital, doctor’s office)?
  • What will be the duration of the treatment?

Secondary cancers from Cisplatin

An unfortunate effect of some chemotherapy drugs is that they can actually cause cancer. Cisplatin interferes with DNA, which leads to cell death. Sometimes it doesn't lead to cell death, though, but instead mutates a healthy cell and makes it malignant. Alkylating agents in particular are associated with these "secondary cancers". It is a risk that you should discuss with your doctor.

Cisplatin is both carcinogenic and mutagenic. It causes mutations in both in vitro and in vivo experimental models. Oncologists weigh this risk with the benefits of cisplatin when determining which drugs to administer.

The International Agency for Research on Cancer classifies cisplatin in category 2A - materials that are probably human carcinogens. They say there is no conclusive evidence the compound is carcinogenic in humans, but there is anecdotal evidence of increased risk, and cisplatin has been found to cause cancer in animals.

New work

Despite being one of the older chemotherapy drugs in use today, cisplatin is still one of the most widely used. And researchers continue to look into it. New combination regimens are often tried in clinical trials, and it is common for newly developed chemotherapy agents to be administered with cisplatin.

Further, researchers at the University of Pennsylvania recently found that modifications to the MRN function (the RAD50 protein) increases the sensitivity of cells to cisplatin. These were cells in a laboratory, but it suggests that there may be a way of clinically improving the function of this anti-cancer drug sometime in the future. Scientists in Australia and Scotland have developed an experimental system where the cisplatin is bound to iron oxide nanoparticles. An external magnet can then move the medicine to the affected organs, lowering systemic distribution and side effects.

Handling Safety

Because it is a hazardous material, healthcare workers are instructed and cautioned to use care when handling cisplatin. The National Institute for Occupational Safety and Health has a website about preventing occupational exposure to chemotherapy agents.

The Institute for Safe Medication Practices lists cisplatin as a drug that has a heightened risk of causing significant patient harm when used in error.