Cisplatin

What Is Cisplatin?

Cisplatin is a type of chemotherapy drug that contains platinum, chlorine and ammonia. Its components work together to enter the DNA of cancer cells. Then, the platinum stops the cells from growing and dividing.

It’s one of the most common types of chemo for treating mesothelioma. However, it’s typically paired with other drugs like Alimta. Trials are testing it with other drugs such as immunotherapy and targeted therapy.

How Is Cisplatin Used to Treat Mesothelioma?

Cisplatin affects the DNA of mesothelioma cells. This slows the growth of mesothelioma tumors. It can even shrink them for some patients.

We spoke with Dr. Jennifer Marie Suga, an oncologist at Kaiser Permanente in Vallejo, CA, about the drug. She explained, “Chemo drugs disrupt cells that divide quickly. They stop cancer from spreading and growing.”

Cisplatin in Chemotherapy Regimens

Cisplatin with Alimta is a common regimen. They’re usually given together every 21 days. Cisplatin and Alimta are both given intravenously. Alimta is usually given first and takes about 10 to 15 minutes. Cisplatin is given next. This usually takes about 2 hours. The dose and number of cycles depend on the patient’s response and side effects.

Doxorubicin may also be used with cisplatin. It’s in a class of drugs called anthracycline. This chemotherapeutic agent is also an antibiotic. It’s made from bacteria and can kill cancer. Doxorubicin plus high cisplatin doses can shrink tumors 50%.

A cisplatin, Alimta and Opdivo combo has been tested. Opdivo is an immunotherapy drug. In a recent mesothelioma clinical trial, the combo was given in cycles. The drugs were administered every 3 weeks in 4-6 cycles. The combo for pleural mesothelioma was a promising option. The disease response rate was 94.4% in trial participants.

Cisplatin for Pleural Mesothelioma

The first-line treatment for mesothelioma is a mix of cisplatin and Alimta. A June 2024 study notes cisplatin is commonly used to treat the disease. But they note there’s a rise in cisplatin resistance. This can make it harder to treat pleural mesothelioma. They said, “the development of resistance to cisplatin significantly limits its effectiveness.”

The researchers studied chemo-resistant diffuse pleural mesothelioma. They tested cisplatin with a targeted therapy. Verzenio (abemaciclib) is FDA-approved for breast cancer. In the study, they found the drug “synergized with cisplatin.” It aslso “reduced the viability of DPM cells with acquired resistance to cisplatin.”

Cisplatin for Peritoneal Mesothelioma

The FDA’s approval of cisplatin and Alimta was for pleural patients. Peritoneal wasn’t specifically mentioned. And a review in October 2024 said in general peritoneal trials are “scant.” The low incidence rate makes it hard to find participants. These authors focused specifically on peritoneal mesothelioma.

In their study, they looked at whole body or systemic therapies. They concluded the best option depends on cell type. Patients with epithelioid cells “may consider” a mix of drugs. This mix is Opdivo, Yervoy, cisplatin and Alimta. For sarcomatoid or biphasic cells, Opdivo plus Yervoy is an option. Immunotherapy shows promise for peritoneal patients.

Impact on Quality of Life

We spoke with Sean Marchese, a registered nurse, about quality of life. He explained some patients experience challenging effects. But he says the benefits outweigh the challenges for many patients.

“Cisplatin chemotherapy has side effects,” he says. “But its main goal is to improve quality of life. It does this by shrinking tumors and easing cancer symptoms. Smaller tumors cause less pain and discomfort. This can improve breathing. On chemo, most patients feel better and can do more.”

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Side Effects of Cisplatin

Cisplatin side effects are usually minor. Common side effects include fatigue and nausea. Cisplatin can lower white blood cell counts. Patients taking this drug face a higher risk of infection.

Many side effects of cisplatin stop after treatment ends. Your doctor can prescribe ways to help manage these effects. For example, anti-nausea drugs can be effective. If your side effects persist or are serious, call your doctor’s office.

There are also rare but serious side effects. Serious kidney problems can happen. Significant hearing loss can also occur. One study found that up to 93% of patients develop permanent hearing loss.

Chemo agents can harm the central nervous system. This can cause effects such as “chemo brain.” Headaches and psychological disturbances are also possible.

Cisplatin’s Black Box Warnings

Cisplatin has multiple boxed warnings. A boxed warning, or black box warning, is the FDA’s strongest drug risk alert. These notices appear on a drug’s labeling and package insert. They warn of possible rare but serious side effects or injuries.

These warnings can help doctors plan to prevent or reduce these effects. They can also raise patients’ concerns. Patients may worry about their treatment plans. They may worry about adverse reactions. Talk to your doctor about any concerns you have with your treatment.

Managing Side Effects

We spoke with Dr. Raja Mudad. He is the medical director of the chemotherapy unit at the Sylvester Comprehensive Cancer Center in Miami. He said, “Most patients have heard about side effects. They’re often wary of chemo because of this misconception.” 

Dr. Mudad explained,
“We have better drugs to prevent side effects now. Most patients don’t have many side effects from chemo.”

Survivor Michael Cole shares, “I know that when I had chemo, they had better drugs than in the past. There are more tools to manage side effects than what they had only a few years ago.”

Who Is a Candidate for Cisplatin?

Usually, those in good overall health are eligible. Cisplatin can cause serious side effects. Those who can likely tolerate these effects qualify. It’s contraindicated for some people. Those with coexisting conditions are less likely to tolerate the drug.

Those allergic to platinum can have serious reactions to the drug. Tell your doctor if you’ve had a reaction to platinum or platinum-based drugs.

People who are pregnant aren’t usually eligible. Cisplatin can harm developing fetuses. The drug may also negatively affect breast milk. If you’re breastfeeding, talk to your doctor.

U.S. Shortage of Cisplatin

On February 10, 2023, the FDA said there was a nationwide shortage of cisplatin. A major manufacturer of the drug shut down after it failed an inspection. The surprise FDA inspection found a “cascade of failure.”

The FDA worked with several manufacturers to end the shortage. Support was provided to increase manufacturing capacity. A drug manufacturer that had stopped making it reentered the market. Importation requirements were also temporarily eased. This allowed more cisplatin to enter the U.S.

On June 27, 2024, the agency reported the shortage has ended. The agency said supply now exceeds demand. But, it suggested there are still supply issues. It said vital drugs are “currently in short supply.” The FDA assured it would keep working with drug makers and doctors. The agency wants to ensure patients have the medicines they need.

Common Questions About Cisplatin for Mesothelioma

Can cisplatin cure mesothelioma?

There is no cure for mesothelioma yet. However, cisplatin when used with other drugs, such as other types of chemo or immunotherapy, have helped patients achieve remission.

How long does a cisplatin chemotherapy session last for mesothelioma patients?

Usually it takes 1-2 hours to administer the drug via IV. Some experts say a slower infusion could reduce side effects. An infusion time of 6-8 hours has even been proposed.

Can cisplatin be used for all types of mesothelioma?

Yes, cisplatin is used to treat all 4 types of mesothelioma. These include pleural, peritoneal, pericardial and testicular.

How is cisplatin different from other chemo drugs used to treat mesothelioma?

Cisplatin has worse side effects than some other chemo drugs. While considered highly toxic, it’s still used widely. It works well for mesothelioma patients when used with other drugs.

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