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Cisplatin is a medication used to manage and treat solid tumors and hematologic malignancies. It is in the alkylating agent class of cytotoxic medications. This activity reviews the indications, action, and contraindications for cisplatinum as a valuable agent in treating malignancy. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for the interprofessional oncology team members in the care of patients with malignancy treated with this agent. Objectives: Identify the mechanism of action of cisplatin. Describe the adverse effects associated with cisplatin therapy. Review the appropriate monitoring necessary with cisplatin therapy. Outline how collaboration and coordination among the interprofessional team can enhance patient care when dosing and monitoring cisplatin to improve patient outcomes for patients receiving antineoplastic therapy with cisplatin. Access free multiple choice questions on this topic.

CIsplatin has several black box warnings, including nephrotoxicity, peripheral neuropathy, severe nausea and vomiting, and myelosupression. Gastrointestinal toxicity - Nausea and vomiting are dose-related side effects that can be severe and lead to metabolic derangements; this can persist for up to 1 week after administration. The strong recommendation is for prophylactic treatment with antiemetic agents.[39][25] Myelosuppression - The chief concern with myelosuppression secondary to cisplatin use is the morbidity and mortality associated with infection. Monitor CBC and frequently assess for signs of infection. High clinical suspicion is necessary for infection and warrants a full workup.[25] Hematologic toxicity may require total treatment interruption. Often it will require dose modification if treatment is to continue.[25] Neurotoxicity - Cisplatin is a dose-dependent neurotoxin.[40] Dose-related neurotoxicity most commonly manifests as peripheral neuropathy. This neuropathy may progress after discontinuation and, in some cases, might be irreversible.[25][41] While dosage may require alteration in the face of neuropathy, high-grade peripheral neuropathy may require total treatment discontinuation. Nephrotoxicity - Severe renal toxicity, including acute renal failure, may occur with Cisplatin administration. These effects are cumulative and dose-related. Pretreatment hydration plays a significant role in preventing renal toxicity.[25][34][35] The dose of cisplatin may require adjustment based on renal function with close monitoring of the glomerular filtration rate (GFR).[33] Ocular toxicity/retinopathy - These adverse effects can manifest in a variety of ways, from loss of color discrimination to cortical blindness. Improvement usually occurs after discontinuation of cisplatin, and in some cases, total recovery may be possible.[25][42] Ototoxicity - Monitoring for ototoxicity includes assessing the patient for ringing in the ears, high-frequency hearing loss, and decreased ability to follow conversations. Deafness has been reported but is not a common effect of cisplatin use. Loss of hearing acuity can be detrimental to language development in pediatric populations.[25][35] Gonadotoxicity - Cisplatin is toxic to the gonads; it can cause impairment of spermatogenesis and dose-dependent ovarian failure leading to premature menopause.[25]

Interprofessional collaboration and care coordination between physicians (particularly oncology specialists), mid-level practitioners, nursing staff, pharmacists, and other healthcare providers enhance team performance and patient outcomes.[43] Working as a team while caring for patients undergoing treatment with cisplatin is of great importance.[44] As a team, monitoring for side effects and toxicity can be more efficient with fewer poor outcomes and earlier intervention.[45][44] Communication among healthcare professionals between various clinical disciplines is crucial. For example, any dose greater than 100 mg/m^2 for a single treatment course requires verification with the initial medication prescriber. The oncology specialty-trained pharmacist should also monitor for the extensive drug-drug interactions with cisplatin and promptly alert the ordering clinician upon finding any reason for concern. Nurses need to be aware of the importance of hydration and monitoring the site of IV infusion for extravasation. Also, all clinicians should monitor the patient for signs of infection, renal impairment, and the development of tumor lysis syndrome. Open communication between the interprofessional team is vital to prevent the adverse effects of this agent while optimizing its therapeutic effect, driving optimal patient outcomes. [Level 5]