Cisplatin: Brands, Price & Uses in Bangladesh

Established / FDA-Approved Uses

• Metastatic testicular tumors: Cisplatin is indicated, in established combination chemotherapy regimens with other cytotoxic agents, for the treatment of metastatic testicular tumors in patients who have already received appropriate surgical and/or radiotherapeutic treatment.
• Metastatic ovarian tumors: Cisplatin is indicated in combination with cyclophosphamide as first-line therapy for metastatic ovarian tumors, and as a single agent in patients with disease previously treated with standard surgical and chemotherapeutic modalities who have not received prior chemotherapy.
• Advanced bladder cancer: Cisplatin is indicated as a single agent for transitional cell bladder cancer that is no longer amenable to local treatment (surgery and/or radiotherapy).

Guideline-Supported / Combination Uses (Broader Oncology Practice)

• Used as part of combination chemotherapy regimens for head and neck squamous cell carcinoma, based on oncology treatment guidelines.
• Used as part of combination chemotherapy (often with radiotherapy, i.e., chemoradiation) for cervical cancer.
• Used as part of combination chemotherapy regimens for non-small cell and small cell lung cancer.
• Used, under oncologist supervision, in combination regimens for other solid tumors such as esophageal and gastric cancer, based on established oncology practice rather than a specific product-label indication.

Cisplatin is a highly toxic cytotoxic chemotherapy medicine and must only be prescribed, dispensed, and administered under the close supervision of a qualified oncologist experienced in the use of cancer chemotherapeutic agents, with adequate facilities for monitoring and managing toxicity.

Cisplatin dosing is individualized by the treating oncologist based on indication, body surface area, prior treatment, and organ function, and is always given as an intravenous infusion with mandatory pre- and post-hydration. Representative regimens described in oncology references include:

Doses greater than 100 mg/m² per cycle every 3 to 4 weeks are rarely used because of increasing toxicity without a clear added benefit.

Mandatory Hydration Protocol

To reduce nephrotoxicity, patients must receive vigorous pre-treatment hydration, typically 1 to 2 liters of intravenous fluid infused over 8 to 12 hours before each dose of Cisplatin. Cisplatin is then administered as an infusion, commonly diluted in dextrose/saline solution with mannitol, over 6 to 8 hours (or per institutional protocol), followed by adequate post-hydration and maintained urine output (generally at least 100 mL/hour) for several hours after the infusion. Adequate hydration and, when required, forced diuresis must be ensured before proceeding with each cycle.

Renal Impairment

Renal function (serum creatinine, BUN, creatinine clearance) and electrolytes must be assessed before the first dose and before each subsequent course; Cisplatin should not be re-administered until renal function has returned to acceptable levels, and dose reduction or delay is required for renal impairment (see Contraindications for pre-existing significant renal impairment).

Hepatic Impairment

No well-established dedicated dose-adjustment guidelines exist for hepatic impairment; use with caution and close monitoring, as directed by the treating oncologist.

Dose modification, delay, or discontinuation may be required for significant myelosuppression, ototoxicity, neurotoxicity, or hypersensitivity reactions, at the discretion of the treating oncologist. Cisplatin must be taken/administered exactly as prescribed; do not alter the schedule, dose, or combination regimen without your oncologist's advice.

Very Common

• Severe nausea and vomiting (highly emetogenic; occurs in almost all patients without adequate antiemetic prophylaxis)
• Nephrotoxicity (kidney impairment; see Precautions and Warnings)
• Myelosuppression: reduced white blood cells, red blood cells (anemia), and platelets
• Ototoxicity: tinnitus and high-frequency hearing loss (see Precautions and Warnings)
• Electrolyte disturbances: low magnesium, potassium, calcium, and sodium

Common

• Peripheral neuropathy (numbness, tingling in hands/feet), which may be irreversible with cumulative dosing
• Loss of appetite, taste changes, fatigue, and weakness
• Hiccups and mild liver enzyme elevations

Serious / Less Common

• Anaphylactic-like reactions (facial swelling, wheezing, rapid heartbeat, low blood pressure), which can occur within minutes of administration, especially on re-exposure
• Ocular toxicity (blurred vision, altered color perception, optic neuritis) with high-dose or prolonged therapy
• Local tissue injury or ulceration if the infusion leaks outside the vein (extravasation)
• Cardiovascular events, including thromboembolism, reported with Cisplatin-based chemotherapy

Patients should seek prompt medical attention for fever, signs of infection, unusual bleeding or bruising, severe or persistent vomiting, ringing in the ears, reduced urination, numbness/tingling, or any signs of an allergic reaction during or shortly after a Cisplatin infusion.