Cisplatin Dosing in Liver Impairment

Primary Recommendation

The American Society of Clinical Oncology recommends standard dosing regimens for cisplatin in patients with hepatic dysfunction, including 100 mg/m² every 3 weeks, 60-80 mg/m² every 3-4 weeks, or 40 mg/m² weekly, depending on the indication and concurrent therapy 1, 2

The National Comprehensive Cancer Network recommends close monitoring of renal function, as cisplatin's elimination is primarily renal, and hepatic metabolism is negligible, with serum creatinine and BUN levels guiding treatment decisions 4, 5
The National Comprehensive Cancer Network advises mandatory pretreatment hydration with 1-2 liters of fluid infused for 8-12 hours prior to dosing, and post-treatment hydration to prevent renal toxicity 4, 5

The National Comprehensive Cancer Network suggests that carboplatin may be substituted for cisplatin in cases of renal dysfunction, although it is inferior in efficacy for most indications, with response rates of 26-42% in patients with renal impairment 6, 7