Class: Alkylating-like platinum analog (DNA crosslinker)
Mechanism: After aquation, forms covalent bonds (primarily 1,2-intrastrand crosslinks) at guanine N7 → DNA damage → apoptosis
Use in Oncology: Backbone drug in many curative and palliative regimens — testicular, ovarian, bladder, cervical, head & neck, NSCLC, SCLC, gastric, pediatric solid tumors
Dosing
- Typical adult: 50–100 mg/m² IV every 3–4 weeks (monotherapy) or 20–80 mg/m² IV every 3–4 weeks (combination)
- Renal adjustment: Avoid or switch to carboplatin if CrCl <50 mL/min
- Requires chloride-containing fluids (0.9% NaCl) for stability and to reduce nephrotoxicity
Key Toxicities & Pharmacist Role
| Toxicity | Notes | Prevention/Monitoring |
|---|---|---|
| Nephrotoxicity (DLT) | Dose- and cumulative-dependent | Pre/post hydration, avoid nephrotoxins, monitor SCr, urine output, electrolytes |
| Ototoxicity | Irreversible, high risk in children | Baseline & periodic audiometry |
| Neurotoxicity | Peripheral neuropathy possible | Neuro exam, dose adjust if severe |
| Severe N/V | Highly emetogenic | Triple antiemetic prophylaxis (NK1 + 5-HT3 + dexamethasone) |
| Electrolyte wasting | Mg²⁺, K⁺, Ca²⁺ | Routine replacement and monitoring |
| Myelosuppression | Usually mild | CBC before each cycle |