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Neoadjuvant Cisplatin

Regimen Cisplatin Dosing Other Drugs Cycles Schedule
GC (Gemcitabine-Cisplatin) 35 mg/m² on days 1 and 8 Gemcitabine 1000 mg/m² on days 1 and 8 4 Every 21 days

Key points about toxicity:

  1. The treatment is generally well-tolerated.
  2. Hematological toxicity:
    • Few cases of grade 4 hematological toxicity were reported.
    • One episode of neutropenic sepsis occurred, which was uncomplicated and managed successfully with intravenous antibiotics.
  3. Non-hematological toxicity:
    • Grade 3 nausea and vomiting occurred in 2 patients.
    • Grade 3 diarrhea was observed in 1 patient.
    • Grade 2 renal toxicity was seen in 1 patient, with a drop in GFR.
    • No clinically significant decline in renal function was noted, even in patients with a baseline GFR of 40-60 ml/min.
  4. Liver toxicity:
    • Transient and reversible liver toxicity was recorded in nearly one-quarter of patients.
  5. Other toxicities:
    • No significant neurotoxicity, ototoxicity, or pulmonary toxicity was observed.
  6. Treatment completion:
    • In one study, 10 patients (12%) were unable to complete 4 cycles of treatment due to complications.

This split-dose regimen appears to have a favorable toxicity profile, allowing for its use in patients with borderline renal function who might be excluded from other cisplatin-based protocols.