Faculty of Medecine, Université de Montréal.
Department of Pharmacy, Centre hospitalier de l'Université de Montréal.
Curr Opin Support Palliat Care. 2020 Sep;14(3):286-292. doi: 10.1097/SPC.0000000000000505.
Cisplatin remains the treatment cornerstone for bladder cancer, either in neoadjuvant or in metastatic (cisplatin-gemcitabine or dose-dense methotrexate, vinblastine, and doxorubicin). Timely and adequate management of cisplatin's adverse events is important in order to avoid dose reductions, treatment delays, or cessation. Over the last years, several randomized studies and updated guidelines have been published on this subject.
The incidence, physiopathology, risk factors, preventive treatment, and optimal management of such complications will be presented, with special focus on cisplatin-associated nausea and vomiting, acute kidney injury (AKI), hypomagnesemia, neurotoxicity, and ototoxicity.
Optimal prevention of cisplatin-associated nausea and vomiting requires an aggressive approach with the use of a four-drug prophylactic regimen (NK1 receptor antagonist, 5-HT3 receptor antagonist, dexamethasone, olanzapine). The use of intensive hydration before and after cisplatin infusion has been the mainstay of AKI prevention. The management of hypomagnesemia and neurotoxicity remains largely symptomatic. In an adult population, no therapy has yet demonstrated benefits in the prevention or treatment of platinum-related ototoxicity.
顺铂仍然是膀胱癌的治疗基石，无论是新辅助治疗还是转移性疾病（顺铂-吉西他滨或剂量密集型甲氨蝶呤、长春碱和多柔比星）。为了避免减少剂量、延迟治疗或停止治疗，及时和充分地管理顺铂的不良反应非常重要。近年来，针对这一主题发表了几项随机研究和更新的指南。
本文将介绍这些并发症的发生率、病理生理学、危险因素、预防治疗和最佳管理，特别关注顺铂相关的恶心和呕吐、急性肾损伤 (AKI)、低镁血症、神经毒性和耳毒性。
最佳预防顺铂相关的恶心和呕吐需要采用积极的方法，使用四药预防方案（NK1 受体拮抗剂、5-HT3 受体拮抗剂、地塞米松、奥氮平）。在顺铂输注前后进行强化水化是预防 AKI 的主要方法。低镁血症和神经毒性的管理仍主要是对症治疗。在成年人群中，尚无任何疗法在预防或治疗铂类相关耳毒性方面显示出益处。
