Cisplatin: the future

Cisplatin is one of the most important anticancer drugs yet developed. It proved critical in the development of curative programs for testicular cancer and in life-prolonging regimens for such diseases as small cell lung cancer, ovarian cancer, and metastatic bladder cancer. Cisplatin currently remains the recommended agent of choice for treatment of several malignancies and is a major reagent in the design of existing clinical trials. Although its analogue, carboplatin, has a constitutional and nonhematologic toxicity profile clearly superior to that of cisplatin, thrombocytopenia associated with carboplatin remains a problem, particularly since it can only be circumvented by means of cellular support, with or without growth factors. Continued laboratory investigations exploring new hypotheses concerning the pharmacodynamics of platinating agents emphasize the importance of the parent compound as well. Thus, in the short term, cisplatin will continue to be used in the therapy of certain major cancers. Ultimately, however, it will be replaced by compounds that both obviate its toxicity and increase its spectrum of activity.