Platinum containing drugs such as cisplatin and the more recently introduced carboplatin, are used as therapeutic agents in a range of neoplastic diseases. The drugs work by interrupting normal DNA replication by forming inter- and intra-strand cross links. After administration, platinum distributes rapidly to most tissues of the body, a large proportion of the dose being excreted within a few hours. The initial high plasma concentration falls quickly and the great majority of the remaining platinum is protein bound.
There is now some interest in the environmental levels of platinum following the introduction of vehicle catalytic converters.
Severe toxic effects, including nephrotoxicity, nausea and vomiting, myelosuppresion and ototoxicity may occur. Excess renal magnesium loss with hypomagnesaemia may be a feature. The effects are less severe with carboplatin than with cisplatin, and nephrotoxicity and ototoxicity are virtually absent.
Laboratory Indices of Toxicity
Measurement of platinum in the plasma to control therapy is not useful. Monitoring focuses on assessment of renal function both prior to and during therapy. In cancer patients who have developed renal failure but in whom continued platinum treatment is deemed to be appropriate, measurement of the plasma concentration may be useful.
Taylor A. Therapeutic uses of trace elements. Clinics in Endocrinology and Metabolism 1985; 14: 703-724
Hodge VF, Stallard MO. Platinum and palladium in roadside dust. Environ Sci Technol 1986; 20: 1058-60
Pezonaga I, Taylor A and Dobrota M. The effects of platinum chemotherapy on essential trace elements. European Journal of Cancer Care 1996; 5: 122-126
Webster PJ, Ng K, Snitch P, Jones SL, Amos N, Harnett. Does determination of tissue platinum levels by mass spectroscopy have potential for monitoring exposure of pharmacy personnel to platinum-based antineoplastic drugs? A pilot study. J Oncol Pharm Practice 1996; 1: 41-8