Cytostatic agent able to inhibit DNA synthesis selectively and specifically. Most active agent in germ-cell tumors and osteogenic carcinoma.
Common in the 1970’s studies: 6 to 14% (six or more doses of cisplatin).
Far less frequent in the 1980’s: only 3 or 4 cisplatin courses in testicular carcinoma; and common use of diphenydramine and dexamethasone in emesis prevention.
Concurrent use of other drugs (bleomycin, actinomycin, vinblastine, cyclophosphamide).
Intravesical use: incidence 10 to 25% (especially if > 8 courses).
Intraperitoneal use: if large doses and high infusion time ratio (>2,2).
Occupational exposure to platinum salts(?).
General: anaphylactic shock (deaths reported).
Cutaneous (most common): pruritus, urticaria, rash, flush.
Respiratory: dyspnea, bronchospasm.
Hematological: hemolytic anemia (or false positive direct antiglobulin test).
Prick-test: 0,1 mg/ ml
Intradermal-test: 0,001 mg/ ml; 0,01 mg/ ml; 0,1 mg/ ml.
Few patients positive to I.D. 0,1 mg/ ml.
One case with positive histamine release test.
IgE-mediated hypersensitivity in some cases (cisplatin acts as a hapten bound to serum proteins).
Direct release of vasoactive substances.
Pretreatment with corticosteroids and antihistamines (sometimes ineffective in preventing IgE-mediated reactions).
Desensitization: a few cases reported.
After premedication with hydroxyzine and methylprednisolone, gradual increase of doses from 1 mg to 80 mg at 30 min intervals.
Cross-reactivity with other platin derivatives (carboplatin, iproplatin and DACPP) is likely.