Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
CISP(RT-W)
Palliative
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
- Primary treatment of cervical cancer with concurrent radiotherapy, including patients:
- With locally advanced cervical cancer
- With bulky clinical stage 1B (>4cm) cervical cancer, who are treated with radiotherapy
- With high-risk early-stage cervical cancer (node positive or margin positive), who will be treated with radiotherapy following hysterectomy
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CISplatin 1 | 40 mg /m² | IV | Day 1 |
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1 Some clinical trials used a maximum cisplatin dose of 70 mg. |
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REPEAT WEEKLY
Concurrently with Radiotherapy. Maximum of 6 weekly doses are usually given.
Moderate
Low
Other Supportive Care:
Follow standard regimens for cisplatin premedication and hydration. Refer to Cisplatin monograph
Dosage with toxicity
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Worst Toxicity in Previous Cycle |
Dose for next cycle*
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Grade 4 platelets, grade 4 ANC ≥ 5 days, thrombocytopenic bleeding or febrile neutropenia |
↓ 25%
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Grade 2 Neurotoxicity /ototoxicity |
↓ 25%
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Grade 3 or 4 Neurotoxicity/ototoxicity
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Discontinue
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Other grade 3 non-hematologic/organ toxicity |
↓ 25%
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Other grade 4 non-hematologic/organ toxicity
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Discontinue
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Hemolysis, optic neuritis, arterial thromboembolism, severe hypersensitivity reactions, grade 3 or 4 ↑ LFTs |
Discontinue
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* do not retreat until platelets ≥ 100 x109/L, ANC ≥ 1.5 x109/L, toxicity has recovered to ≤ grade 2 (grade 1 for neurotoxicity) and creatinine ≤ ULN |
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Hepatic Impairment
No adjustment required
Renal Impairment
In general, renal function should have normalized before patients are retreated. If continued treatment is considered to be mandatory, the following dose modifications could be considered at the physician's discretion:
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Creatinine clearance
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% previous dose
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46-60
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75%
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30-45
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50%
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<30
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Discontinue
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Dosage in the Elderly
Geriatric patients may be at higher risk of developing nephrotoxicity, ototoxicity/neurotoxicity or hematologic adverse effects with cisplatin.
| Most Common Side Effects | Less Common Side Effects, but may be Severe or Life Threatening |
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Recommended Clinical Monitoring
- CBC; baseline and regular
- Renal function tests; baseline and regular
- Electrolytes, including magnesium, sodium, potassium, phosphate and calcium; baseline and regular
- Audiogram; baseline and as clinically indicated
- Clinical toxicity assessment of infection, bleeding, nausea/vomiting, neurotoxicity, ototoxicity, thromboembolism; regular
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
Suggested Clinical Monitoring
- Audiogram; periodic
- Liver function tests; baseline and regular
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DiSilvestro PA, Ali S, Craighead PS, et al. Phase III randomized trial of weekly cisplatin and irradiation versus cisplatin and tirapazamine and irradiation in stages IB2, IIA, IIB, IIIB, and IVA cervical carcinoma limited to the pelvis: a Gynecologic Oncology Group study. J Clin Oncol 2014;32(5):458-64.
Dueñas-González A, Zarbá JJ, Patel F, et al. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol 2011 May 1;29(13):1678-85.
Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340:1154-61.
Lanciano R, Calkins A, Bundy BN, et al. Randomized comparison of weekly cisplatin or protracted venous infusion of fluorouracil in combination with pelvic radiation in advanced cervix cancer: a gynecologic oncology group study. J Clin Oncol 2005 Nov 20;23(33):8289-95.
Pearcey R, Brundage M, Drouin P, et al. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 2002;4:966-72.
Pu J, Qin S-s, Ding J-x, et al. A randomized controlled study of single-agent cisplatin and radiotherapy versus docetaxel/cisplatin and radiotherapy in high-risk early-stage cervical cancer after radical surgery. J Cancer Res Clin Oncol. 2013;139(4):703-8.
Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53.
Ryu SY, Lee WM, Kim K, et al. Randomized clinical trial of weekly vs. triweekly cisplatin-based chemotherapy concurrent with radiotherapy in the treatment of locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2011 Nov 15;81(4):e577-81.
Sehouli J, Runnebaum IB, Fotopoulou C, et al. A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study. Ann Oncol 2012;23(9):2259-64.
Wang S, Zhang D-S, Pan T, et al. Efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on advanced cervical cancer. Chin J Cancer. 2010;29(11):959-63.
Zuliani AC, Esteves SCB, Teixeira LC, et al. Concomitant cisplatin plus radiotherapy and high-dose-rate brachytherapy versus radiotherapy alone for stage IIIB epidermoid cervical cancer: a randomized controlled trial. J Clin Oncol 2014;32(6):542-7.
February 2021 Added additional references; modified Drug Regimen footnote
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
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