What Is Cisplatin?

Cisplatin is one of the most widely used chemotherapy drugs for treating mesothelioma. When combined with pemetrexed (Alimta), it leads to the longest survival rates of any chemotherapy combination tested on mesothelioma.

Cisplatin Information

Cisplatin
  • Other names: Platinol, Platinol-AQ, DDP, CDDP and cisplatinum

  • Manufactured by: Bristol-Myers Squibb, Teva Pharmaceuticals, Tocris Bioscience, others

  • FDA-approved: Yes (to treat testicular, bladder and ovarian cancer)

  • Used or tested in: Germ cell tumors, lymphoma, sarcoma, small cell lung cancer, ovarian cancer and mesothelioma

Cisplatin was approved by the U.S. Food and Drug Administration (FDA) in 1978 to treat testicular cancer and is still used in the treatment of several cancers today.

When it is given alone, cisplatin has a relatively low response rate of less than 15 percent in most people with pleural mesothelioma. However, when combined with other chemotherapy medications, patients experience improved response rates. For example, the combination of cisplatin and pemetrexed (Alimta) is the most effective chemotherapy regimen for pleural mesothelioma. Treatment with this therapy has been shown to prolong life expectancy.

Cisplatin in Mesothelioma Treatment

Throughout treatment, mesothelioma patients receive the combination of cisplatin and pemetrexed every 21 days. The medication pemetrexed is given through an IV and typically takes about 10 to 15 minutes to complete. A dose of cisplatin delivered intravenously follows this step and usually takes about two hours to administer. The dose and number of cycles required will depend on the patient’s response to treatment as well as any side effects experienced.

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The basic use of cisplatin is to promote apoptosis, also known as cell death. It is recommended that patients start taking a B12 supplement orally one week before treatment begins. Patients will likely receive weekly B12 shots throughout treatment in addition to taking a daily folic acid supplement, which will continue for 21 days after the last treatment cycle. An oral steroid may be prescribed to minimize side effects.

Side Effects

Many chemotherapy side effects will subside when treatment ends. If a side effect lingers long after treatment has ended, reach out to your oncologist and explain your condition so they may prescribe medication to help you recover.

Side effects that may be experienced by mesothelioma patients receiving the chemotherapy drug cisplatin include:

  • Fatigue
  • Nausea
  • Vomiting
  • Hair loss
  • Diarrhea
  • Hearing loss
  • Kidney toxicity
  • Changes in taste
  • Low red blood cells (anemia)
  • Low white blood cells (neutropenia)
  • Numbness or tingling in the fingertips and toes

Mesothelioma patients who experience any of the following symptoms after receiving cisplatin should notify their doctor:

  • Fever
  • Chills
  • Dizziness
  • Diarrhea
  • Seizures
  • Rash
  • Black stools
  • Unusual bruising or bleeding
  • Swelling of the feet or ankles
  • Shortness of breath or wheezing

In some cases, patients receiving this drug can experience extreme side effects such as severe organ damage. The central nervous system can also be affected by alkylating-like agents, leading to side effects such as “chemo brain,” headaches and psychological disturbances.

Studies

In unique cases, high doses of this drug combined with doxorubicin have been effective in shrinking mesothelioma tumors in half. Three small trials using more conventional doses of the two drugs produced positive response rates, but the results should await confirmation from larger clinical trials.

Promising results were also noted in the combination of cisplatin and gemcitabine in Australia, with a partial response rate of 47.6 percent among 21 patients. Median survival was 41 weeks (about 10 months). Most of the responses were seen in mesothelioma patients diagnosed with the epithelioid subtype, and symptom relief was correlated with response to treatment.

In a 1996 study, Dr. Sugarbaker and other researchers combined extrapleural pneumonectomy with radiation therapy and chemotherapy with cisplatin, doxorubicin and cyclophosphamide in 120 patients. The overall survival was 45 percent at two years and 22 percent at five years.

In 1999, Dr. Sugarbaker reported a five-year survival rate of 46 percent in patients with epithelial cell type, lymph nodes free of cancer and clean surgical margins (the latter meaning that little to no cancer cells were detected post-surgery). Most of the participants in this study received cisplatin in combination with doxorubicin and cyclophosphamide after surgery, with radiation therapy following chemotherapy.

A 2016 phase III clinical trial added bevacizumab to cisplatin and pemetrexed with a positive impact on overall survival. Pleural mesothelioma patients who received all three drugs lived an average of 18.8 months compared to 16.1 months among those who only received cisplatin and pemetrexed.

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Karen Selby, RN and Patient Advocate at The Mesothelioma Center

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Sources
  1. CVAX. (n.d.). Information on the chemotherapy drug cisplatin. Retrieved from http://www.cisplatin.org/
  2. Baldi, A. (2008).Mesothelioma from Bench Side to Clinic. Nova Science Publishers: New York.
  3. Robinson, B. & Chahinian, P. (2002).Mesothelioma. Martin Dunitz: London.
  4. NCI. (2014, May 30).The "Accidental" Cure — Platinum-based Treatment for Cancer: The Discovery of Cisplatin. Retrieved from https://www.cancer.gov/research/progress/discovery/cisplatin
  5. Troy, L., et al. (2000). Cisplatin-based therapy: a neurological and neuropsychological review. Psychooncology; 9(1):29-39. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10668057
  6. Sugarbaker, D., et al. (1996). Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Ann Surg; 224(3):288-94. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8813257
  7. Sugarbaker, D., et al. (1999). Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg; 117(1):54-63. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9869758
  8. Zalcman, G., et al. (2016). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet; 387(10026):1405-1414. doi: 10.1016/S0140-6736(15)01238-6

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