1. What is cisplatin?
2. Who might be offered cisplatin?
3. How cisplatin is given
4. Common side effects of cisplatin
5. Less common side effects of cisplatin
6. Sex and contraception
8. Blood clots
Cisplatin is a chemotherapy drug used to treat breast cancer
Chemotherapy destroys cancer cells using anti-cancer drugs.
Cisplatin may be used to treat people with:
- secondary breast cancer – breast cancer that has spread from the breast to another part of the body
- locally advanced breast cancer (also known as regional recurrence) – breast cancer that has spread to the tissues and lymph nodes (glands) around the chest, neck and under the breastbone
- primary breast cancer – cancer that has not spread beyond the breast or the lymph nodes under the arm. Cisplatin may be given after surgery (known as adjuvant chemotherapy) in combination with other anti-cancer drugs. Sometimes it’s given before surgery (known as primary or neo-adjuvant chemotherapy)
You may be offered cisplatin as part of a clinical trial. Research is looking into the benefits of using cisplatin in specific types of breast cancer such as triple negative breast cancer or breast cancer that has developed due to inheriting an altered BRCA gene.
Cisplatin is given as a drip into a vein (intravenously) in the hand or arm, although there are other ways of giving it depending on factors such as how easy it is for chemotherapy staff to find suitable veins and your preferences.
Cisplatin is usually given once every three weeks. This pattern is known as a ‘cycle’ or ‘course’. How often cisplatin is given, whether it’s given with other drugs and the total number of cycles will depend on your particular situation. Your specialist team will discuss this with you.
When cisplatin is given on its own, it takes between 30 and 120 minutes, but the total time may be longer when it’s given with other drugs.
Before starting your treatment, many hospitals arrange a chemotherapy information session. At this appointment a nurse will discuss how and when your chemotherapy will be given and how side effects can be managed. Contact numbers will also be given so you know when and who to phone if you have any questions or concerns.
Everyone reacts differently to drugs and some people have more side effects than others. The side effects described here will not affect everyone and most can usually be controlled. If you’re being given other chemotherapy or anti-cancer drugs with cisplatin you may also have side effects from those drugs.
If you’re concerned about any side effects, whether they’re listed here or not, tell your chemotherapy nurse or cancer specialist (oncologist).
Effects on the blood
Cisplatin can temporarily affect the number of healthy blood cells in the body.
You’ll have regular blood tests to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.
Not having enough white blood cells can increase the risk of getting an infection.
Contact your hospital immediately if:
- you have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- you suddenly feel unwell, even with a normal temperature
- you have any symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold and/or shivery
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your specialist team know. A blood transfusion may be necessary during your treatment if the number of red blood cells falls significantly.
Cisplatin can reduce the number of platelets, which help the blood to clot. You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your specialist team if you have any of these symptoms.
Nausea and vomiting
You may experience nausea (feeling sick) and vomiting (being sick), although many people will not actually be sick. You’ll be given anti-sickness medication into your vein before the chemotherapy is given, and you’ll be prescribed anti-sickness drugs to take home to reduce nausea or stop it happening.
It’s common to feel extremely tired during your treatment. For some people, fatigue can last for several weeks or even months after the treatment has finished, but your energy levels should gradually return.
Find out more about different ways of coping with and managing fatigue.
Effects on your concentration (‘chemo brain’ or cognitive impairment)
Your ability to concentrate or think clearly can also be affected, which can be very frustrating. This is often referred to as ‘chemo brain’ or ‘chemo fog’, but your specialist team may call it cognitive impairment. It usually improves over time after treatment has finished.
Effects on fertility
Cisplatin causes changes in the ovaries, which may lead to infertility in women who haven’t been through the menopause. The likelihood of you becoming infertile may also depend on whether you have had chemotherapy in the past and your age.
If you’re concerned about your fertility, it’s important to talk to your specialist team before treatment begins to discuss options for preserving fertility.
Sometimes cisplatin can cause women who haven’t been through the menopause to experience menopausal symptoms. This is because it affects their ovaries, which produce oestrogen.
Common symptoms can include:
- hot flushes and night sweats
- mood changes
- joint aches and pains
- vaginal dryness
Changes to your appetite
Your appetite may change while you’re having cisplatin. This may last for a few days, but if you’re concerned about how much you’re eating and drinking speak to your specialist team.
Sore mouth and taste changes
You’ll be given mouthwash to try to reduce soreness of the mouth and gums and to try to stop mouth ulcers developing. Good mouth hygiene is very important during treatment.
It’s advisable to see your dentist for a dental check-up before chemotherapy begins and to avoid dental treatment during chemotherapy.
While you're having cisplatin your taste can change and some food may taste different (for example more salty, bitter or metallic). This usually returns to normal once you have finished treatment.
Cisplatin may cause hearing impairment or ringing in the ears (tinnitus). This is usually temporary and improves once treatment has finished. Let your doctor know if you experience any hearing loss or tinnitus.
Liver or kidney changes
As cisplatin can affect your liver and kidneys, your team will check these are working normally (usually with blood tests) before starting treatment and throughout your treatment. Any effect cisplatin has is usually mild and will get better by itself.
Numbness and tingling in hands or feet (peripheral neuropathy)
Some people having cisplatin have numbness or tingling in their hands and feet. This is due to the effect of cisplatin on the nerves and is known as peripheral neuropathy.
In most cases it’s mild and goes away soon after treatment stops, although in some cases it can be permanent. If it’s severe, it may be necessary to reduce the dose of cisplatin or to stop it completely.
If you have numbness or tingling, tell your specialist team so that the symptoms can be monitored.
Diarrhoea or constipation
You may have diarrhoea or constipation but your specialist or GP can prescribe medicine to help control this. Contact your specialist chemotherapy team if you have four or more episodes of diarrhoea within a 24-hour period.
Pain in the injection site (extravasation)
If chemotherapy drugs leak out of the vein it’s being given in (called extravasation), it can damage the surrounding soft tissue.
Tell the nurse giving the chemotherapy immediately if you have any pain, stinging or a burning sensation around the cannula (small plastic tube) while the drug is being given.
If you have an allergic reaction to cisplatin, it will probably happen within the first few minutes of your treatment and is most likely the first or second time you have the drug. Reactions can vary from mild to severe, but severe reactions are uncommon.
You’ll be monitored closely so that any reaction can be dealt with immediately.
Symptoms of an allergic reaction include:
- skin rash
- back pain
- shortness of breath
- high temperature or chills
If you have a severe reaction, treatment will be stopped immediately.
If you have a reaction, medication can be given before future treatments to reduce the risk of further reactions.
You’re advised not to become pregnant while having treatment because cisplatin may have a harmful effect on a developing baby.
If you haven’t been through the menopause, talk to your team about the most suitable method of birth control for you.
You can still have sex during treatment. As it’s not known if chemotherapy drugs can pass into vaginal fluids (or semen), most hospital specialists advise using barrier methods of contraception, such as condoms, for a few days after chemotherapy is given.
You shouldn’t have any live vaccines while you’re having chemotherapy. Live vaccines include measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.
It’s safe to have these vaccines six months after your chemotherapy finishes. Talk to your GP or specialist before having any vaccinations.
If someone you live with needs to have a live vaccine speak to your specialist or GP. They can advise what precautions you may need to take depending on the vaccination.
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have or already having chemotherapy. The flu vaccine is not a live vaccine so doesn’t contain any active viruses. If you’re already having chemotherapy, talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab.
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Having cisplatin increases the risk of blood clots such as a deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away:
- pain, redness/discolouration, heat and swelling of the calf, leg or thigh
- swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- shortness of breath
- tightness in the chest
- unexplained cough (may cough up blood)
Find out more about blood clots.