Cisplatin — Drug Monograph

Brand names: Platinol, Platinol-AQ

Drug class: Alkylating Agent

Mechanism of Action

Platinum-based compound that forms intrastrand and interstrand DNA cross-links (predominantly at N7 of guanine), inhibiting DNA replication and transcription. Activates apoptotic pathways. Cell-cycle non-specific.

FDA Indications

• Metastatic testicular cancer (in combination)
• Metastatic ovarian cancer (in combination)
• Advanced bladder cancer

Common Side Effects

• Severe nausea and vomiting (highest emetic risk of any chemotherapy)
• Nephrotoxicity (elevated creatinine, hypomagnesemia, hypokalemia)
• Peripheral neuropathy (glove-and-stocking paresthesias)
• Myelosuppression
• Ototoxicity (tinnitus, high-frequency hearing loss)
• Fatigue
• Hypomagnesemia, hypokalemia, hypocalcemia, hypophosphatemia
• Alopecia (less than with anthracyclines)

Clinical Pearl

Magnesium replacement is essential — cisplatin causes tubular magnesium wasting that persists between cycles. Prophylactic magnesium supplementation (MgSO4 1–2 g IV or magnesium oxide 400–800 mg PO daily) reduces the severity of hypomagnesemia and may reduce nephrotoxicity.

Related Therapies & Mechanisms

• Carboplatin (Paraplatin) — Alkylating Agent · NSCLC
• Pembrolizumab (Keytruda) — NSCLC
• Nivolumab (Opdivo) — NSCLC
• Paclitaxel (Taxol) — NSCLC