Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 1 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

Cisplatin is similar to the bifunctional alkylating agents. It covalently binds to DNA and disrupts DNA function7. After

cisplatin enters the cells, the chloride ligands are replaced by water molecules.8,9 This reaction results in the

formation of positively charged platinum complexes that react with the nucleophilic sites on DNA.2 These platinum

complexes covalently bind to DNA bases using intra-strand and inter-strand cross-links creating cisplatin-DNA

adducts thus preventing DNA, RNA and protein synthesis.7 This action is cell cycle phase-nonspecific.10 Cisplatin

also has immunosuppressive, radiosensitizing, and antimicrobial properties.2

Interpatient variability systemic clearance resulting in variable blood platinum concentrations or AUCs11

Oral Absorption not absorbed12

rapidly diffuses into tissues13 highest concentrations found in the liver, prostate and kidney;

rapidly distributed into pleural effusions and ascitic fluid

cross blood brain barrier? not readily10

volume of distribution14 ultrafilterable platinum*: 41 L/m²

Distribution

plasma protein binding >90%5,11,13

undergoes non-enzymatic conversion to several inactive metabolites which are highly

bound to plasma proteins12

active metabolite yes

Metabolism

inactive metabolite yes10

primarily in the urine8

urinary excretion of ultrafilterable platinum* was substantially greater after a 6-hour infusion

than after a 15-minute injection15

urine > 90%8; 25% excreted during the first 24 h7

feces insignificant

terminal half life of ultrafilterable

platinum*8,11,16,17

20-45 min

terminal half life of total

platinum*8

5 days or longer

Excretion

clearance 6.3 mL/min/kg

Gender no clinically important differences found

Elderly no clinically important differences found

Children terminal half life of ultrafilterable platinum* < 1 h12

terminal half life of total platinum* 24-72 h12

Ethnicity no clinically important differences found

Adapted from standard reference17 unless specified otherwise.

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 2 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

*Ultrafilterable platinum consists of non-protein-bound intact drug and metabolites, total platinum consists of all

platinum species, both protein-bound or –unbound.8 Note that it is the platinum that is usually measured.

* Bladder cancer Adrenal carcinoma2

Brain cancer Anal cancer2

Cervical cancer Breast cancer2

Esophageal cancer Choriocarcinoma2

Gastric cancer Endometrial cancer2

Germ cell tumours Kidney cancer2

Gestational trophoblastic neoplasia Liver cancer2

Head and neck cancer Lymphomas2

Lung cancer, non-small cell Melanoma2

Lung cancer, small cell Penile cancer2

Lymphoma, Hodgkin’s disease Sarcoma2

Lymphoma, non-Hodgkin’s Thyroid cancer2

Mesothelioma

Nasopharyngeal cancer

Osteosarcoma

* Ovarian cancer

Prostate cancer

*Testicular cancer

*Health Canada approved indication

impairment.14

compounds.

receiving cisplatin for testicular cancer, almost all became azospermic within the first two cycles of therapy, but

recovery of normal sperm morphology, motility, and sperm count occurred in 40% within 1.5-2 years.

2 L of fluid infused 8-12 hours prior to a cisplatin dose.17 Hydration with NS, hypertonic saline infusion, and mannitol,

or furosemide-induced diuresis is used to effectively decrease cisplatin-induced nephrotoxicity.8 Lower doses of

cisplatin are given with less intensive hydration. For example, patients receiving doses of 35 mg/m2 have been pretreated

with 500 mL NS over 1 hour, with no post-hydration. Patients receiving doses of 25 mg/m2 have been pretreated

with vigorous oral hydration (e.g., 600-900 mL) the morning of treatment and 8 glasses (e.g., 2000 mL/day)

be taken to avoid overdosing such as writing the cisplatin dose as a daily dose, not as a total cisplatin dose used in

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 3 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

one course of therapy. The manufacturer recommends that an alerting mechanism be instituted to verify any order

for cisplatin >100 mg/m2 per course every 3-4 weeks.

in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for

a serious disease for which safer drugs cannot be used or are ineffective).

The table includes adverse events that presented during drug treatment but may not necessarily have a causal

relationship with the drug. Because clinical trials are conducted under very specific conditions, the adverse event

rates observed may not reflect the rates observed in clinical practice. Adverse events are generally included if they

were reported in more than 1% of patients in the product monograph or pivotal trials, and/or determined to be

clinically important.19

I = immediate [onset in hours to days]; E = early[days to weeks];

D = delayed [weeks to months] L = late [months to years]

allergy/immunology hypersensitivity (rare) I

vestibular toxicity (rare) E

blood/bone marrow/

febrile neutropenia

I

cardiovascular

(arrhythmia)

arrhythmias13 E

cardiovascular (general) bradycardia (rare) E

E

constitutional symptoms hiccoughs I

alopecia (uncommon) E

rash (uncommon) E

local soft tissue toxicity (rare) E

endocrine glucose intolerance13

diarrhea E

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 4 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

I = immediate [onset in hours to days]; E = early[days to weeks];

D = delayed [weeks to months] L = late [months to years]

loss of taste E

pancreatitis13 E

stomatitis10 E

hepatic transient elevation of hepatic enzymes and bilirubin I

metabolic/laboratory elevated serum amylase I

hyperuricemia E

musculoskeletal muscle cramps E

neurology autonomic neuropathy E

dorsal column myelopathy E

Lhermitte’s sign E

seizures (rare)7 E

ocular/visual visual impairment (rare) E

altered colour perception E

blurred vision E

cerebral blindness (infrequent) E

optic neuritis E

papilledema E

secondary malignancy acute leukemia (rare)10 L

syndromes inappropriate antidiuretic hormone syndrome E

Adapted from standard references2,16,17 unless specified otherwise.

Cisplatin has been shown to sensitize red blood cells, sometimes resulting in a direct Coombs’ positive hemolytic

anemia.17

Hypophosphatemia and hyponatremia have occurred in some patients receiving cisplatin combination regimens.2

These effects are due to renal tubular damage. Cisplatin greatly increases the urinary excretion of magnesium and

calcium; increased excretion of potassium, zinc, copper and amino acids also occurs. Hypomagnesemia and or

hypocalcemia may become symptomatic, with muscle irritability or cramps, clonus, tremor, carpopedal spasm and/or

tetany. Children may be at greater risk for developing hypomagnesemia.

vomiting may occur within 1-6 (usually 2-3) hours after administration of cisplatin.2 This early period is the most

severe and usually lasts 8 hours, but can last up to 24 hours. Various levels of nausea, vomiting and anorexia may

when complete emetic control had been attained on the day of cisplatin therapy. The incidence and severity of

cisplatin-induced nausea and vomiting appear to be increased in: females, the young, high doses, rapid infusion and

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 5 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

combinations with other emetogenic drugs. Incidence and severity may be decreased in patients with a history of

granisetron, ondansetron) plus a corticosteroid; this can be continued for the first 24 hours following chemotherapy.

evidence that some patients can benefit from 5-HT3 antagonists19, generally these agents are ineffective more than

24 hours after chemotherapy.21 Corticosteroids are the cornerstone of the treatment for delayed nausea, although

renal insufficiency, hypokalemia and hypomagnesemia. The risk for these adverse effects is related to the dose and

interval of cisplatin and may be minimized by adequate hydration. Geriatric patients may also be at increased risk.

cisplatin dose.17 Others suggest hydration with NS, hypertonic saline infusion, and mannitol, or furosemideinduced

diuresis to effectively decrease cisplatin-induced nephrotoxicity.8

Refer to protocol by which patient is being treated. Numerous hydration regimens exist. Hydration regimens should

take into account the following conditions for the patient ; adequate renal function, clinically euvolemic prior to

administration of cisplatin, no contraindication to saline loading (e.g., uncompensated cardiac conditions, anasarca),

and ability to comply with recommended oral hydration protocol, or expectation that volume status can be

maintained (e.g., with fluids via enteral feeding tube or IV). Below is one suggested hydration regimen for adults.22

> 80 4000 mL* NS over 4 h KCl 20 mEq

MgSO4 1 g

Mannitol 30 g

inpatient or medical daycare

unit admission to monitor urine

output

60-80 2000 mL* NS over 2 h KCl 20 mEq

MgSO4 1 g

Mannitol 30 g

40-60 1000 mL* NS over 1 h KCl 10 mEq

MgSO4 0.5 g

includes regimens with cisplatin

administered over multiple days

<40 500 mL* NS over 30 min none includes regimens with cisplatin

administered over multiple days

*Volume may include hydration associated with the administration of other drugs (e.g., other chemotherapy agents,

supportive IV medications). The volumes and durations are minimum administration standards to accommodate the

wide variation in clinical practice in delivery of cisplatin. They should be individualized based on the clinical situation,

which may affect the hydration regimen and addition of electrolytes.

In children, for moderate to high-dose cisplatin give pre-hydration at 125mL/m2/h for a minimum of 2 hours to

increase urine output to >100 mL/m2/h (> 3 mL/kg/h).23 The hydration fluid most commonly used is D51/2NS +

10mEq/L KCL. In post-hydration maintain urine output at 65-100 mL/m2/h with oral/IV fluids.23 D51/2NS + 20 mEq/L

KCL + 20 mEq MgS04 + mannitol 20 g/L is commonly used for IV post-hydration.23

and lower extremities).2 They can also include motor difficulties (especially gait); reduced or absent deep-tendon

reflexes and leg weakness may also occur. Peripheral neuropathy is cumulative and usually reversible, although

recovery is often slow.13 Geriatric patients may be at greater risk for these cisplatin-induced neuropathies. Muscle

cramps have been reported, and usually occurred in patients with symptomatic peripheral neuropathy who received

relatively high cumulative doses of cisplatin. Lhermitte’s sign (a sensation during neck flexion resembling electric

shock) often is present with cisplatin-induced neuropathy. The occurrence of Lhermitte’s sign may coincide with the

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 6 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

onset of peripheral neuropathies, and can last for 2-8 months. When signs of neuropathy occur, cisplatin should be

discontinued.

and irreversible and results from damage to the inner ear.13 These effects may be more severe in children than in

adults.10 The manufacturer recommends that audiograms be performed prior to initiating therapy and prior to each

subsequent dose of drug.17 Initially, there is loss of high frequency acuity (4000 to 8000 Hz). When acuity is affected

in the range of speech, cisplatin should be discontinued under most circumstances and carboplatin substituted

where appropriate. Ototoxicity appears to be dose related. Higher cumulative doses, higher individual doses and

administration by IV bolus resulted in more severe ototoxicity24, corresponding with higher plasma levels of

ultrafilterable platinum.15 Ototoxicity may be enhanced in patients with prior or simultaneous cranial irradiation.

Vestibular ototoxicity may increase with increasing cumulative dosage and may be more likely to occur in patients

with pre-existing vestibular dysfunction.

respiratory difficulties, tachycardia, and hypotension.17 These reactions can occur within a few minutes after IV

administration of cisplatin; diaphoresis, nasal stuffiness, rhinorrhea, conjunctivitis, generalized erythema,

apprehension, and sensation of chest constriction may also occur. Cisplatin-induced anaphylactoid reactions usually

have occurred after multiple cycles of cisplatin (e.g., at least 5 doses), but also can occur after the first dose.2 There

is a case report of a patient who experienced an anaphylaxis to cisplatin following nine previous uncomplicated

cycles.25Occasionally, patients who experienced anaphylactoid reactions have been safely retreated with cisplatin

following pre-treatment with corticosteroids and/or antihistamines; however, such prophylaxis is not uniformly

effective in preventing recurrence.

etoposide synergistic antineoplastic

activity against testicular,

small cell lung and, nonsmall

cell lung cancers

possible impaired

elimination of etoposide in

patients previously treated

with cisplatin

some protocols are

designed to take

advantage of this effect;

monitor toxicity closely

nephrotoxic drugs such as

aminoglycoside antibiotics

and amphotericin

increased risk of

nephrotoxicity

cumulative nephrotoxoixity use with extreme caution

during or shortly after

cisplatin

ototoxic drugs such as

aminoglycoside antibiotics

or loop diuretics (e.g.,

ethacrynic acid,

furosemide)

increased risk of ototoxicity cumulative ototoxicity carefully monitor for signs

of ototoxicity

phenytoin decreased phenytoin

serum levels

decreased absorption

and/or increased

metabolism of phenytoin

monitor serum levels of

phenytoin

pyridoxine26 decrease in cisplatin

activity

further investigation

required

avoid concomitant use of

pyridoxine with cisplatin

renally excreted drugs increase the serum levels

of renally excreted drugs

reduced renal function

caused by cisplatin

monitor toxicity

Adapted from standard references2 unless specified otherwise.

mg/100 mL) at a concentration of 1 mg/mL.17 Unopened vials are stored at room temperature. Do not refrigerate or

freeze cisplatin solutions as a precipitate will form. Protect from light.

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 7 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

Do not use IV needles, syringes or sets that have aluminum components in the preparation or administration of

cisplatin.17 An interaction between aluminum and platinum will occur resulting in the formation of a black precipitate,

accompanied with a loss of potency.

of mannitol.17 The solution is not preserved and should be used within 24 hours. Any unused portion should be

discarded. In children, the administration volume of cisplatin should be maintained at >125 mL/m²/hr, and contain

mannitol 15 g/m2 and MgSo4 20 mEq/L.23 Urine output should be maintained at > 90 mL/m²/hr during

administration.23

chlorpromazine, cimetidine, cladribine, cyclophosphamide, dexamethasone, diphenhydramine, doxorubicin,

doxorubicin liposome, droperidol, famotidine, filgrastim, fludarabine, fluorouracil, furosemide, ganciclovir,

gatifloxacin, gemcitabine, granisetron, heparin, hydromorphone, leucovorin, linezolid, lorazepam, melphalan,

methotrexate, methylprednisolone, metoclopramide, mitomycin, morphine, ondansetron, paclitaxel,

prochlorperazine, promethazine, propofol, ranitidine, sargramostim, teniposide, topotecan, vinblastine, vincristine,

vinorelbine.

The following are compatible with cisplatin in the same syringe in certain concentrations: bleomycin,

cyclophosphamide, doxapram, doxorubicin, droperidol, fluorouracil, furosemide, heparin, leucovorin, methotrexate,

metoclopramide, mitomycin, vinblastine, and vincristine.

The following are compatible with cisplatin in the same infusion bag in certain concentrations and diluents:

carboplatin, cyclophosphamide with etoposide, etoposide, etoposide with floxuridine, etoposide with mannitol and

KCL, floxuridine, floxuridine with leucovorin, hydroxyzine, ifosfamide, and ifosfamide with etoposide, leucovorin,

magnesium, mannitol, ondansetron and paclitaxel.

The following solutions are compatible with cisplatin at the stated concentrations: cisplatin 50 mg, 500 mg, 300 mg in

D51/2NS 1L; cisplatin 50 mg, 300 mg, 500 mg in D5NS 1L; cisplatin 50 mg, 100 mg, 200 mg in D51/2NS with

mannitol 1.875%; cisplatin 300 mg in D5W 1L; cisplatin 50 mg, 100 mg, 167 mg, 200 mg, 300 mg, 500 mg, 600 mg,

900 mg in NS 1L; cisplatin 50 mg, 100 mg, 200 mg in 1/2NS.

cefepime, piperacillin-tazobactam and thiotepa.

The following are incompatible with cisplatin in the same infusion solution at the stated concentrations: cisplatin 200

mg with etoposide 400 mg, mannitol 1.875%, KCl 20 mEq in NS 1L; cisplatin 200 mg with fluorouracil 1 g in NS 1L;

cisplatin 500 mg with fluorouracil 10 g in 1L NS; cisplatin 67 mg with mesna 3.33 g in NS 1L; cisplatin 67 mg with

mesna 110 mg in NS 1L; cisplatin 200 mg with paclitaxel 1.2 g in NS 1L; cisplatin 200 mg with thiotepa 1 g in NS 1L.

The following solutions are incompatible with cisplatin at the stated concentrations: cisplatin 100 mg/L in D5W 5%;

cisplatin 75 mg/L in D5W; cisplatin 50 mg/L in Sodium bicarbonate 5%; cisplatin 500 mg/L in Sodium bicarbonate

5%.

Subcutaneous no information found

Intramuscular no information found

Direct intravenous not to be administered by the direct IV route

(administration over 24 hours may decrease nausea,

vomiting and nephrotoxicity)

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 8 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

Intraperitoneal has been used16

Intrapleural has been used5

Intrathecal no information found

Intra-arterial has been used16

Intravesical has been used28

Refer to protocol by which patient is being treated. Numerous dosing schedules exist and depend on disease,

response and concomitant therapy. Guidelines for dosing also include consideration of absolute neutrophil count.

Dosage may be reduced, delayed or discontinued in patients with bone marrow suppression due to

cytotoxic/radiation therapy or with other toxicities.

Cycle Length:

(total dose per cycle 25-40 mg/m2)

(total dose per cycle 90 mg/m2)

(total dose per cycle 20-100 mg/m2)

(total dose per cycle 120 mg/m2)

(total dose per cycle 40 mg/m2)

(total dose per cycle 60 mg/m2)

(total dose per cycle 75 mg/m2)

(total dose per cycle 100 mg/m2)

(total dose per cycle 70-100 mg/m2)

(total dose per cycle 75-90 mg/m2)

(total dose per cycle 75 mg/m2)

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 9 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

Cycle Length:

(total dose per cycle 40 mg/m2)

(total dose per cycle 100 mg/m2)

(total dose per cycle 100 mg/m2)

(total dose per cycle 75 mg/m2)

available, refer to Appendix 6 "Dosage Modification for Myelosuppression"

Creatinine clearance mL/min59 Cisplatin dose

> 60 100%

45 - 59 75% cisplatin or go to carboplatin

option (if available)

< 45 hold cisplatin or delay with additional

IV fluids or go to carboplatin option (if

available)

Calculated creatinine clearance = N* x (140 - Age) x weight

Serum Creatinine in μmol/L

* For males N = 1.23; for females N=1.04

Cycle Length:

3 weeks: 90 mg/m2 IV one dose on day 1

3-4 weeks: 60 mg/m2 IV one dose on day 1 and day 2

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2. McEvoy GK, editor. AHFS 2004 Drug Information. Bethesda, Maryland: American Society of Health-System Pharmacists, Inc.;

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3):117-37.

5. Pizzo P, Poplack D. Principles and Practice of Pediatric Oncology. Fourth ed. Philadelphia: Lippincott Williams & Wilkins; 2002.

p. 256-9.

6. National Institute for Occupational Safety and Health (NIOSH). Preventing occupational exposures to antineoplastic and other

hazardous drugs in healthcare settings. Cincinnati, Ohio: NIOSH - Publications Dissemination; 25 Mach 2004. p. 71-83.

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Revised: August 2005

7. Chabner BA, Longo DL. Cancer chemotherapy and biotherapy. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p.

453-9.

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1999;17(1):409-22.

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1987;12.

13. O'Dwyer P, Stevenson J, Johnson S. Clinical Pharmacokinetics and Administration of Established Platinum Drugs. Drugs 2000

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16. McEvoy GK, editor. AHFS 1989 Drug Information. Bethesda, Maryland: American Society of Health-System Pharmacists, Inc.;

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17. Mayne Pharma (Canada) Inc. Cisplatin Product Monograph. 2003 date of revision.

18. Perry M, M.D. FACP. The Chemotherapy Source Book. In. Baltimore, Maryland: Williams & Wilkins; 1992. p. 405-9.

19. Christopher Lee, MD. Personal Communication. Medical Oncologist, BC Cancer Agency, Fraser Valley Cancer Centre 2005.

20. B.C. Cancer Agency Provincial Systemic Therapy Program. Provincial Systemic Therapy Program Policy III-20: Prevention and

management of extravasation of chemotherapy. Vancouver, British Columbia: BC Cancer Agency; 1 February 2004.

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22. BC Cancer Agency Genitourinary Tumour Systemic Policy Group. Administration of cisplatin in the outpatient setting. BC

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23. Arthur R. Supportive care of children with cancer. 2nd ed. Baltimore: John Hopkins University Press; 1997.

24. Balis FM, Holcenberg JS, Bleyer WA. Clinical Pharmacokinetics of Commonly Used Anticancer Drugs. Clin Pharmacokinet

1983;8:202-32.

25. Basu R, Rajkumar A, Datta RN. Anaphylaxis to cisplatin following nine previous uncomplicated cycles. Int J Clin Oncol

2002;7:365-7.

26. Wiernik P, Yeap B, Vogl S, et al. Hexamethylmelamine and low or moderate dose cisplatin with or without pyridoxine for

treatment of advanced ovarian carcinoma: a study of the Eastern Cooperative Oncology Group. Cancer Invest 1992;10(1):1-9.

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gastrointestinal tract cancer (gastric, esophageal, gall bladder carcinoma and cholangiocarcinoma) using infusional fluorouracil and

cisplatin. (GIFUC). Vancouver: BC Cancer Agency; 2001.

30. BC Cancer Agency Head and Neck Tumour Group. BCCA Protocol summary for recurrent and metastatic nasopharyngeal

cancer using cisplatin and etoposide (HNDE). Vancouver: BC Cancer Agency; 2004.

31. BC Cancer Agency Gynecology Tumour Group. BCCA Protocol summary for treatment for high risk gestational trophoblastic

cancer (GOTDHR). Vancouver: BC Cancer Agency; 2005.

32. BC Cancer Agency Genitourinary Tumour Group. BCCA Protocol summary for palliative therapy for urothelial carcinoma using

cisplatin and gemcitabine (GUAVPG). Vancouver: BC Cancer Agency; 2002.

33. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for neo-adjuvant therapy for urothelial carcinoma

using cisplatin and gemcitabine (UGUNAJPG). Vancouver: BC Cancer Agency; 2005.

34. BC Cancer Agency Genitorinary Tumour Group. BCCA Protocol summary for nonseminoma consolidation/salvage protocol

using etoposide, cisplatin, ifosfamide, mesna (GUVIP2). Vancouver: BC Cancer Agency; 2005.

35. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for adjuvant cisplatin and etoposide following resection of

stage I, II and IIIA non-small cell lung cancer (LUAJEP). Vancouver: BC Cancer Agency; 2001.

36. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for treatment of advanced non-small cell lung cancer with

platinum and gemcitabine (LUAVPG). Vancouver: BC Cancer Agency; 2005.

37. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for first-time treatment of advanced non-small cell lung

cancer with cisplatin and docetaxel (LUCISDOC). Vancouver: BC Cancer Agency; 2005.

38. BC Cancer Agency Gynecology Tumour Group. BCCa protocol summary for treatment of small cell carcinoma of cervix using

paclitaxel, cisplatin, etoposide and carboplatin with radiation (GOSMCC2). Vancouver: BC Cancer Agency; 2002.

39. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for consolidation/salvage treatment for germ cell

carcinoma using vinblastine, cisplatin, ifosfamide and mesna (GUVEIP). Vancouver: BC Cancer Agency; 2003.

40. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for therapy of genitourinary small cell tumours with

a platin and etoposide (GUSCPE). Vancouver: BC Cancer Agency; 2003.

41. BC Cancer Agency Head and Neck Tumour Group. BCCA Protocol summary for advanced head and neck cancer using

cisplatin and fluorouracil (HNFUP). Vancouver: BC Cancer Agency; 2005.

42. BC Cancer Agency Head and Neck Tumour Group. BCCA Protocol summary for intensive cisplatin and etoposide

chemotherapy for recurrent and metastatic head and neck cancer (HNPE). Vancouver: BC Cancer Agency; 1999.

Cisplatin

BC Cancer Agency Cancer Drug Manual© Page 11 of 11 Cisplatin

Developed: September 1994

Revised: August 2005

43. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for treatment of limited stage small cell lung cancer

alternating cyclophosphamide, doxorubicin and vincristine with etoposide and cisplatin plus early thoracic irradiation (LUALTL).

Vancouver: BC Cancer Agency; 2002.

44. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for palliative therapy of selected solid tumours using

cicplatin and etoposide (LUPE). Vancouver: BC Cancer Agency; 2004.

45. BC Cancer Agency Lung Tumour Group. BCCA protocol summary for ctreatment of limited stage small-cell lung cancer with

etoposide and cisplatin and early thoracic irradiation (LUPESL). Vancouver: BC Cancer Agency; 2004.

46. BC Cancer Agency Gynecology Tumour Group. BCCA Protocol summary for non-dysgerminomatous ovarian germ cell cancer

using bleomycin, etoposide and cisplatin. Vancouver: BC Cancer Agency; 2001.

47. BC Cancer Agency Gynecology Tumour Group. BCCA Protocol summary for therapy of dysgerminomatous ovarian germ cell

cancer using cisplatin and etoposide. Vancouver: BC Cancer Agency; 2001.

48. BC Cancer Agency Genitourinary Tumour Group. BCCA Protocol Summary for Bleomycin, Etoposide, Cisplatin for

Nonseminoma Germ Cell Cancers (GUBEP). Vancouver: BC Cancer Agency; 2002.

49. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for therapy for etoposide - cisplatin protocol for

germ cell cancers (GUBP). Vancouver: BC Cancer Agency; 2005.

50. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for therapy for transitional cell cancers of the

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stage 3 non-small cell lung cancer (LUCMT-1). Vancouver: BC Cancer Agency; 2005.

52. BC Cancer Agency Gynecology Tumour Group. BCCA Protocol Summary for Treatment of Advanced/Recurrent Non-Small

Cell Cancer of the Cervix with Cisplatin and Etoposide (GOCXADV). Vancouver: BC Cancer Agency; 2000.

53. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for combined modality therapy for sqamous cell

cancer of the genitourinary system using fluorouracil and cisplatin (GUFUP). Vancouver: BC Cancer Agency; 2005.

54. BC Cancer Agency Neuro-Oncology Tumour group. BCCA Protocol Summary for adjuvant lomustine, cisplatin and vincristine

in adult high-risk medulloblastoma or other primitive neuro-ectodermal tumour (PNET) - CNCCV. Vancouver: BC Cancer Agency;

2002.

55. BC Cancer Agency Gynecology Tumour Group. BCCA Protocol summary for treatment of high risk squamous cell carcinoma of

cervix with concurrent cisplatin and radiation. (GOCXRADC). Vancouver: BC Cancer Agency; 2002.

56. BC Cancer Agency Genitourinary Tumour Group. BCCA protocol summary for therapy for locally advanced bladder cancer

using concurrent cisplatin with radiation. (GUBP). Vancouver: BC Cancer Agency; 1999.

57. BC Cancer Agency Head and Neck Tumour Group. BCCA Protocol summary for combined chemotherapy and radiation

treatment for locally advanced squamous cell carcinoma of the head and neck (HNCMT2). Vancouver: BC Cancer Agency; 2004.

58. BC Cancer Agency Gastrointestinal Tumour Group. BCCA Protocol Summary for combined modality therapy for locally

advanced esophageal cancer using cisplatin, infusional fluorouracil and radiation therapy. (GIEFUP). Vancouver: BC Cancer

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59. International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with

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