Clinical implications of cisplatin pharmacology

Extensive investigation is taking place to overcome the nephrotoxic manifestations and the gastrointestinal intolerance of cisplatin. Various modes of administration are being explored for this purpose with different schedules, infusion durations, hydration programs, and diuretic regimens. Pharmacokinetic studies suggest that such manipulations may lead to considerable variations in cisplatin excretion and in peak plasma levels of the non-protein-bound species. The clinical impact of these pharmacokinetic alterations is not currently apparent. This should be clarified with additional studies of the behavior of non-protein-bound platinum and its relationship to clinical efficacy and toxicity.